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.

@mbosnz

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.

I am sure I'd feel completely differently if I'd ever suffered any sort of trauma previously and I totally appreciate why it would be uncomfortable for someone who has. I was being flippant I'm sorry

Oh and for the PP who asked whether I would take an organ donation, that’s a moot point as with the delays for treatment many people are unable to even access a diagnosis on NHS, nevermind treatment. I’ve not had good experiences with them either, have been left disabled and with chronic pain due to NHS negligence.

I’ve been in both situations, I think for intimate procedures or examinations then it should be limited to one student, I certainly don’t agree with multiple students watching gynae procedures. If there are signs around the hospital or GP practice etc saying this is a teaching hospital, students may be present, but you can opt out of them being there, then imo the onus is on you to speak up, tell them receptionist prior to going into the clinic room if it’s that big of a deal to you to refuse with the student there. It’s the same if you don’t want a male HCP, you either need to speak up when you enter the clinic room and see one, or if you know that’s going to be uncomfortable for you call in advance or tell the receptionist.

Students have to learn, I’ve had gynae procedures performed by doctors who are training and being supervised, yes I would have preferred someone more experienced doing the procedure, but people have to learn and this is the only way. I work in a large teaching hospital and there are signs everywhere saying students may be present, so it shouldn’t be a shock when you come into my clinic room and are introduced to a student.

But yes I agree it’s not good practice to bring students in without introducing them, it’s also not good practice to allow multiple students in to see intimate procedures and you should always ask patients for consent prior to a student (or anyone for that matter) performing a procedure, so I would absolutely complain if that has happened to anyone.

No worries, hangrylady! I may come across as rigid and harsh, but that's because I am completely not prepared to have to explain the reason I have a strict no medical students rule, and get quite angry if I feel I'm put in the position where I either have to do so, or come across as a right grumpy, unreasonable cow.

I find seeking medical treatment difficult in and of itself, and avoid doing so. So being put in the position of having to say no to a breezy medical professional on their turf, along with their eager beaver of a student, is not helpful in overcoming my reluctance!

This thread is scarily eye opening re coercion. The Nuremberg code obviously hasn’t gone viral 😞

The thing is, when you are having a medical procedure, you kind of are a mannequin.

No I'm not. I'm a person.

I agree OP, I hate when you're asked but put into an awkward position as well. It's always hard to get blood out of me, the midwife asked if I'd mind having a student try I said sorry no, I'd rather if you did it and the midwife said nope well I'm not doing it she needs to learn- I said okay ill get it done at the GP and she looked shocked. Had a painful examination in labour and asked the midwife to stop, she said sure. A minute later a student comes in with a different midwife, can she repeat the examination please, again, awkward saying no. Other scenarios been more than happy to say yes.

People do have to learn I agree, and many people don't mind and some are happy with some procedures and not others, absolutely fair enough.

I'm a nurse, so I understand the importance of students having hands on experience or even just sitting in.

My local dentist, GPs and hospitals do have signs warning of students being present and aay to let staff know in advance if you don't want them in the room.

However, as a nurse, first and foremost its my job to teach new students patient consent and respect. I'm not doing that if I just foist a student upon you. Consent is a constant thing, and should be sought at very new interaction.

So...

'This is Becca my student, is it okay if she sits in'

'Is it okay with you if Becca weighs you/ does your BP/steps closer to watch this procedure'

At no point should the patient be made to feel uncomfortable for refusing

@greenmarlin

The thing is, when you are having a medical procedure, you kind of are a mannequin.

No I'm not. I'm a person.

There was a doctor, who sadly died of cancer, who started the 'Hello my name is' campaign. It was to stop hospital doctors talking about a patient to students and other staff without first introducing themselves, and anyone else, to the patient. It is the same principle in any area of medicine, precisely because the patient is absolutely not a mannequin and must never, ever be thought of as one .

How do we deal with this?

You have

People who don't mind the student being in room when asked the question, and would answer honestly regardless of feelings

People who are traumatised and then (seperately) people just in general up in arms about the thought of a student being there when you are asked consent

Then people like me, who panic if asked the question but the student is not there. I panic and overthink. I'd much rather see both student and practitioner together and be asked in front of both of them so I can decide if I'm comfortable then and there

So.... What then?

I get why in certain situations you may feel uncomfortable and have the right to refuse however the students really really need to learn so of course they are going to be there. They are the future nurses, doctors, dentist and consultants and need the learning experiences?

They need the learning experiences, but that does not mean that every one has to provide them with those learning experiences. That is why meaningful and informed consent is supposed to be sought.

My local dentist, GPs and hospitals do have signs warning of students being present and aay to let staff know in advance if you don't want them in the room

Several people have expressed disbelief about students at the dentist and I’ve never experienced it before this occasion. This is the first I have heard about dentists having signs about students.

I wonder what has changed.

@Itsalmostanaccessory That’s not very nice, it’s on me that I don’t follow daily news after trying to survive a suicide attempt? I was actually advised to avoid the news due to my mental illness.

@RegardingMary

I'm a nurse, so I understand the importance of students having hands on experience or even just sitting in.

My local dentist, GPs and hospitals do have signs warning of students being present and aay to let staff know in advance if you don't want them in the room.

However, as a nurse, first and foremost its my job to teach new students patient consent and respect. I'm not doing that if I just foist a student upon you. Consent is a constant thing, and should be sought at very new interaction.

So...

'This is Becca my student, is it okay if she sits in'

'Is it okay with you if Becca weighs you/ does your BP/steps closer to watch this procedure'

At no point should the patient be made to feel uncomfortable for refusing

This!

When I was a student i never minded if it wasn't appropriate for me to sit in, no matter the reason, because respect and consent were held in Hugh esteem on my course. And I never mind now if a patient declines a student now. The patient is at the centre of each interaction, they are who is important. For every patient who declines, there are plenty more who do consent so I'm not worried about the future of my profession.

Then people like me, who panic if asked the question but the student is not there. I panic and overthink. I'd much rather see both student and practitioner together and be asked in front of both of them so I can decide if I'm comfortable then and there

Well, I guess you could ask to see the student and practitioner together - from what you've said, you feel the onus is on you to ensure you give informed consent, as a patient?

*high, even

@AngelinaFibres Dr Kate Granger, she sounds like a lovely human, tragic that she died so young.

I had a student/ newly qualified person doing a heart scan At the end she said rather awkwardly “ I just need to speak to my supervisor” which put the terrors up me as I assumed she had seen some thing wrong! When he came in it turned out she had done the scan wrong, and all was well. My worst experience was at Hammersmith Hospital when I had 10 students ( I counted them) at a pregnancy appointment .......

We get a lot of trainee dentists and hygienists.

In fact a few times I've had a trainee for examinations it's been fine and I've got a scale and polish which I never tend to get from the dentist. I may reconsider if it was a procedure similar to a root canal and I did refuse before we got in the room when DD went for an extraction, she was 7 and I didn't want it taking a second longer than needed to.

How do we deal with this?

Then people like me, who panic if asked the question but the student is not there. I panic and overthink. I'd much rather see both student and practitioner together and be asked in front of both of them so I can decide if I'm comfortable then and there

Maybe you could get a card printed out to let them know you’re special and should be asked in front of both.

@MarbleQueen

How do we deal with this?

Then people like me, who panic if asked the question but the student is not there. I panic and overthink. I'd much rather see both student and practitioner together and be asked in front of both of them so I can decide if I'm comfortable then and there

Maybe you could get a card printed out to let them know you’re special and should be asked in front of both.

Oooof!

@PickledGhost You sound like you know what real consent is, lovely to see. But it should be standard for everyone else too :)

@winterchills

I get why in certain situations you may feel uncomfortable and have the right to refuse however the students really really need to learn so of course they are going to be there. They are the future nurses, doctors, dentist and consultants and need the learning experiences?

And there will always be plenty of people who will have zero objection to have them present.

Doesn't mean everyone has a duty to do it. We have different levels of comfort around privacy/nakedness not to mention cases of anxiety stemming from prior abuse/trauma. And we all deserve to be treated with consideration and respect, not be used as props by default.

Getting prior clear consent simply protects the most vulnerable patients, it's not going to prevent those who are open to it from continuing to volunteer. So where's the harm?