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.

In all the situations I’ve had a student present within an appointment they are usually already in the room usually due to the quick turn around of the appointments and them having a debrief after each patient.

But i am always made aware that they are a student giving me the chance to say if I would like them to leave.

I understand it can be uncomfortable in some situations and it is perfect okay to ask them to leave.

I’m a student paramedic and for us it is a little different as I’m always with my crew and always go into the house with them but I make that patient aware that I am a student and will constantly seek consent first of all for me to be in the room and then for anything that I carry out on the patient if they say they would prefer I don’t do it them my mentor (paramedic) with then proceed to treat that patient.

I feel it is upto the student to make the patient aware who they are and gain consent. I am forever grateful to all of the patient who have allowed me to be in the room/ treat them as without them I wouldn’t be able to learn and we would run out of health care workers.

@mbosnz Wow, you re-phrased that so well and patiently. I wish I had your command of the English language 😭

I think if you’re particularly nervous or sensitive about this topic it’s best to tell the person at the desk or call ahead first, or if possible bring someone with you to advocate for you.

Hopefully it wouldn't be too much of an imposition to require this to be communicated to patients, prior to the appointment? Not just by signs, which not all can read, but by the receptionist either at the time of making the appointment, or when reporting for the appointment, or preferably both, actually specifically stating this to patients? So patients can give genuine informed consent?

@Elsiebear90

This! This! This! Sorry lol but perfectly summed up

@mbosnz

Running out of spooons but basically see the lovely insightful reply which I've been trying to communicate all throughout!

Nice talking to people and informed consent is clearly essential!

@AutomaticMoon

As already mentioned several times it was ALL OVER the news, radio, TV adverts, cinemas, social media…. You’ve been called out because you have no idea what you’re talking about. Stop sprouting lies.

Oh and not everyone has a mobile phone but then the NHS - you know the ones who changed the law would be blamed for that with you too.

Go and educate yourself

I don't quite get the spoons, unless you're talking about spoonfeeding? In which case, up there with calling people 'hun', that's not really appropriate in what should be a mutually respectful discussion.

@JustLyra ‘Then the answer surely is “Do you mind if a female student observes?” or “Do you mind if a male student observes?” rather than shoving all the responsibilities onto patients?

Especially when the most vulnerable patients are the ones least likely to feel able and confident enough to object in front of said student.’

Seconded!

mbosnz

Not to sound heartless but personal phonecalls re this are an imposition. Services don't have the time or the staff.... People may not pick up, redial back while staff are busy, it may make mh worse ect.

Only time we gave calls like this were home visits on the day (obvious reasons)

Also agree with Njbrookes comments

What's the difference between me being willing to begrugenly adapt to having to ask the potential student to be in room so i can decide ... And people having to adapt to having to ask if student is not there for informed consent qs ?

If you find it that hard to speak up then phone ahead and inform them you want to be asked in front of the student. Or get an advocate to do it for you.

I went for a contraception check up before having kids and was asked if I
Minded a student being there
No says I and then it turned out the student was a girl in the year above me at my school

mbosnz

Oh sorry! I'm disabled and running out of energy to think properly so don't want to keep talking much longer as things get miscommunicated when I'm tired/in pain like now lol

It's been a great thread with a lot of insightful comments. Thanks for replying respectfully :nice talking to you :)

@rubystiles They could have sent a letter then to inform everyone, for those without a mobile phone, or a landline phone call. I have no idea what I’m talking about and I’m spouting lies, regarding my own lived experience? If you say so 🙄

“Then the answer surely is “Do you mind if a female student observes?” or “Do you mind if a male student observes?” rather than shoving all the responsibilities onto patients?

Especially when the most vulnerable patients are the ones least likely to feel able and confident enough to object in front of said student.”

It’s the responsibility of the patient to not give consent if they don’t want to consent, unless they are being pressured in anyway then that consent is valid.

In this day and age with gender pronouns and what not it’s not always as simple as calling someone male or female. Also, sometimes people just feel uncomfortable with someone regardless of gender and find it hard to articulate why, as a patient I’ve had HCPs I feel comfortable with and other ones for some reason I don’t, I’d find it quite hard to then revoke consent upon seeing someone and explain why in that situation.

MarbleQueen

You have got to be kidding me.

I said this right at the bloody beginning. For the opposite situation. Got a load of grief and what, now people originally telling me how wrong i was to suggest that... suddenly... Parrot back what I'm saying??

,

Um, when I'm talking about phone calls, I'm talking about when the patient has rung up to make an appointment. Not about another phone call being made. If the onus is to be on the patient to give informed consent prior to reaching the consulting room, then when the appointment is made, the person making the appointment with the patient could (and should) ensure the patient is okay (or not) with students present. This could be repeated when they report to reception.

That way the patient is not ambushed at any stage of the consultation, and the student either can, or cannot be present, as per the patient's wishes.

Informed consent is not just a tick box, or it shouldn't be. It shouldn't be a bother. Practitioners who think it is, and treat it like it is, are the problem, not patients who don't meekly accede to the practitioner's default practices and preferences.

Back in the days when you had face to face GP appointments 🙄 our surgery regularly had students in. They always got consent. When you arrive the receptionist initially tells you and asks if you mind. Then when you get in for your appointment the GP introduces the student & confirms your consent

When I was in hospital there were students at times. If it was just the consultants rounds nothing was said but if the consultant wanted to do any kind of examination (none were intimate examinations) he always checked for consent

@HonestwithHope1

mbosnz

Oh sorry! I'm disabled and running out of energy to think properly so don't want to keep talking much longer as things get miscommunicated when I'm tired/in pain like now lol

It's been a great thread with a lot of insightful comments. Thanks for replying respectfully :nice talking to you :)

Hope you get some rest, and are in less pain soon!

@user1497207191 ‘ was troubled with attitude at a recent GP appt. I phoned for an appt and was told it would be a phone consultation unless I agreed to a medical student appt with GP supervision. Clear intention that if I wanted face to face I had to accept a medical student.’

That’s not real consent 😞

[quote AutomaticMoon]@mbosnz Wow, you re-phrased that so well and patiently. I wish I had your command of the English language 😭[/quote]
Thank you AutomaticMoon, that's very kind!

@mbosnz

I think if you’re particularly nervous or sensitive about this topic it’s best to tell the person at the desk or call ahead first, or if possible bring someone with you to advocate for you.

Hopefully it wouldn't be too much of an imposition to require this to be communicated to patients, prior to the appointment? Not just by signs, which not all can read, but by the receptionist either at the time of making the appointment, or when reporting for the appointment, or preferably both, actually specifically stating this to patients? So patients can give genuine informed consent?

Consent is informed as long as the patient has capacity, all the relevant information is given at the time and there is no pressure put upon the patient, you imagining or feeling like there is pressure or that there will be consequences for refusing when there was none doesn’t make the consent invalid or not informed. Someone could argue that without meeting the student they are being asked to provide consent for then that consent isn’t informed as they don’t know who they are being asked to allow in.

Tbh I’ve worked in the NHS for years and I’ve never actually come across this being an issue when the patient was asked at the time and the student was properly introduced (seen complaints when that didn’t happen), so until it is raised as an issue I don’t see any reason to add extra work for the receptionists by changing the procedure as most patients seem to be happy with seeing the student first.

MarbleQueen

You have got to be kidding me.

I said this right at the bloody beginning. For the opposite situation. Got a load of grief and what, now people originally telling me how wrong i was to suggest that... suddenly... Parrot back what I'm saying??

Yes it’s a daft response isn’t it.

‘Oh, and the law and professional guidance are both equally clear that compliance does not equal consent.

Consent must be freely given, informed, and capacitous otherwise it is not legally valid.’

I copied this from a thread about membrane sweeps without consent, thought the bit about ‘compliance doesn’t equal consent’

*is relevant to this thread. I’m sorry if it’s not.

@MarbleQueen 😝

So, a person should tell the person at the desk, or call ahead first, or bring an advocate - even though they haven't been told they should do this if there is an issue? The onus is on them, but they're not given the information, but that's okay, because as far as you're concerned most (but clearly not all, given the responses here) 'seem to be happy' with seeing the student first?