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.

Plus I love it when they explain loads of stuff to the student as I get to know so much more about the process, which fascinates me.

I once forgot they weren’t teaching me and started asking questions about the process too 😂

Your doctor is only capable of their job because they did the training you are wanting to deny the students.

Consent is at the centre of medical care, which your coercive comments suggest you do not understand. It is no patient's responsibility to be violated for training purposes.

I have had students observe in the past but I ALWAYS have been asked before hand.

I do think students need to be there for the educational and experience but I would expect to be asked and not taken for granted.

@Globaluser

I personally wouldn’t mind students being present and don’t even expect to be told if they are. But any of them actually preforming any procedure on me, well I’d like to be asked. It should be written consent in my opinion, you know, in case something goes wrong.

If something went wrong when a student was performing a procedure, it's on the qualified health professional they're with. It's the qualified staff's insurance which would cover them in that situation. Not to make you worried/concerned, but it usually means that they're damn sure they're supervising the students correctly.

I work in higher education, in health care professions; and the only time I ask for there not to be students, is when they're from my own Uni, and they will see me in my pants (or less). I'm responsible for student conduct and discipline, and I lose any gravitas that I ever had, if they see me puking into a bucket, whilst having a catheter put in. I don't mind them taking blood, examining my knee, looking at my eyes, - any of that. Smear test, catheter insertion/removal, mammogram - not appropriate. The only time I would demur from that would be in an emergency.

Students have to learn sometime.... and they will be failed/have a fitness investigation if they don't take consent, either in simulation/Uni setting, or in a practice-based learning experience.

I have noticed they no longer ask if you are okay with training nurses etc being at apps. I don't mind tbh, they need to learn.

@shouldistop

When my grandpa was dying I was sitting by his hospital bed holding his hand when a doctor barged into the room with a gaggle of students and proceeded to tell them why he was dying etc. The doctor hadn't even spoken to ME about why he was dying (although I knew from my mum). He was so abrupt and clinical talking to the students and ignoring me sitting there that I burst into tears. A few of the students had the good Grace to look awkward and apologetic.

This pretty much happened to me when i was in ICU but I'm not sure if they were classed as students or the equivalent of "interns" / newly qualified doctors.

One of them came over to explain what the lead doctor had said when he went to find my notes or something & i told him "I know I've got xyz. I'm not deaf." he had the decency to look embarrassed but i hope he learnt that day that a hello to an awake/alert patient would be good!

I did feel a little mean but I also don't think they expected an 18 year old on their own to be so outspoken... A lot of doctors & some nurses during my stay expected to a lot meaker & to just fo along with what they said I think!
The students were actually the nicest!

I had a gynae issue a few years ago and there was a male student in with the female consultant & nurse. I said fine but I would ask him to leave at a certain point. That point came & I turned to him and said "Right, off you go then. Bye". From the look on his face I don't think he expected me to actually get him to leave. But I didn't move to get undressed until he left the room. My body, my choice.

I’ve never known any HCP to assume it’s ok, they’ve always asked my permission for a student to be present.
However it’s important to remember that the NHS is desperately understaffed, if we want any kind of decent healthcare we must support the training of new staff.

Personally I've found students to be far more considerate and conscientious than the qualified professional they are learning from, however it should absolutely be your choice, especially if they will be performing any procedures. I dont think it's helpful for people to say what they would or wouldn't have a problem with because we are all different and your feelings are valid so if you are uncomfortable then of course you are not being 'silly' to speak up and say so.

I've had two very positive experiences of students. One was my 12 week scan where the baby was in the perfect position, the professor (who was doing the scan!) Asked if we minded some stuff being explained to the students about early sex indicators... it was fascinating. He did it all in the local language and English for our benefit and we got to see baby in 4D.

Second was DD2, home birth and I was asked prior to labour if I'd be OK with a student attending and again when I was in labour to see if it was still OK.

Both times I felt completely respected. The students need to learn.

Well something must’ve changed because in 2020 the NHS felt entitled to enrol all citizens on the organ donor list, without asking or anything.

I shouldn’t have to ask them to leave because they shouldn’t be there in the first place until I’ve agreed. And it’s clearly assuming consent instead of actively seeking it.

I’ve previously been asked by a receptionist or the gp which is completely different.When I’ve agreed they’ve then gone and informed the student they can come in.Putting someone in a awkward position by TELLING you in front of them isn’t informed consent.

You don’t know if they were medical students or junior doctors though. People have to learn and patients who refuse are in my view akin to the unvaccinated allowing others to bear the burden of risk while they enjoy the benefits

I don’t give a shit what they are. If they don’t understand consent I don’t want them around or anywhere near me. I’m there to have a procedure done and I want it done with privacy and expertise. I don’t want to be practised on without my consent and I definitely don’t want 3 teenagers gawking at me while I’m having a smear.

Gosh you’ve been terribly unlucky. I’ve never experienced this, in fact only yesterday I had an appointment with our GP for my baby son and he advised that he had a student doctor with him for the day, and asked if it was okay if she sat in and further asked whether it was okay if he involved her in the consultation. I can’t see any reason at all for you having not been asked consent at any one of your appointments.

You've just reminded me OP that during the 3rd and 4th (failed) attempts to induce labour, the consultant brought 2 or 3 student/junior doctors in to stand and watch me getting the pessary put into my extremely swollen, and agonisingly sore at this point, vagina.

I did not appreciate it, I did not want them there, and I was not asked.

@AutomaticMoon

Well something must’ve changed because in 2020 the NHS felt entitled to enrol all citizens on the organ donor list, without asking or anything.

You know you can opt out.

And it has come to my attention that women under anaesthesia are having pelvic examinations without being asked for consent or even informed of it. But this has been going on forever, I think, not a recent thing. I’ve seen on a medical forum, how entitled the surgeons and doctors feel to do whatever they want.

I had a student at our surgery they were encouraged with my consent to ask a couple of questions. It wasn't intimate. I hope they learnt something

@shouldistop To opt out of something you first have to be aware that it’s happening. How can people opt out when the NHS did this without telling people in the first place.

@rjaksieh

Just ask for them to leave if you're not happy.

Mind you I do wonder how you expect all these medical professionals to be there to help you in the future if you don't want them to learn somehow 🧐

Personally I've found student nurses and midwives (both of which I've been very happy to have around) to be some of the very best care I have received. They always seem to still have enthusiasm and been happy to go the extra mile. Plus I love it when they explain loads of stuff to the student as I get to know so much more about the process, which fascinates me.

I would say that I would agree on having students in, as I had the most wonderful student nurse sat with me most of the night during an emergency ambulance transfer between hospitals, and for hours after, whilst I was admitted, and prepped for surgery at 4am. She even called the ward to speak to me a couple of days later, to check how I was. I often think about her, her knowledge, reassurance, and kindness (this wee, composed, 19 year old, and snotty mess, terrified, 40 something year old me), and hope that my loved ones might be cared for by her in the future. From experience, she will be a cracking nurse.

Consent is obviously very important here. I’ve always been asked about whether I kind a student being present. If not you have every right to complain and it sends a dreadful message to students about how to treat patients.

Was the midwife a student or newly qualified and doing her first delivery. I think the consent might be slightly different but maybe midwives here comment. Either way you should have been informed and emphasis on your needs and reassurance.

There were times during the course of some gruelling treatment I could not deal with being touched, or needed the reassurance that the person performing care on me was experienced. I was ok for students to watch still.

The poster who likened refusal to consent to refusal to get a vaccination needs a crash course in consent.

[quote AutomaticMoon]@shouldistop To opt out of something you first have to be aware that it’s happening. How can people opt out when the NHS did this without telling people in the first place.[/quote]
It was widely publicised. How did you know about it?