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.

Did you miss the part about the letters having information on how they can be translated? The information is given prior to the observer arriving because it’s on the letters sent to patients which can be translated into their language if they don’t speak English, so they know ahead of the appointment that there may students there as it’s a teaching hospital and they can decline if they wish to. It’s not just sprung on them when they turn up.

A fifth of people in the UK are considered functionally illiterate. Letters simply may not cut it.

@Flickflak

Letters having information in them on how to organise a translation…… not very helpful to the person needing the translation!!

The languages available and the phone numbers to access them are at the top of the letters, easy to pick out. How else can they get the info out? Council tax etc would go up astronomically if all correspondence had to be sent out in all languages!!

I'm a doctor, and I'm utterly horrified at what some of you have endured- I'm so sorry. I think it's clear that different people have different ways that they would prefer for consent to be discussed. Would it be fair to say that most people would be happy if the doctor/ nurse met you on the way to their room and asked before you entered? I know a few people wanted to see the student to gauge how they felt, but I think that was a minority compared to the people who felt that added pressure.

With regards to 'they have to learn', yes we do; but we don't have to learn at the cost of the patient's comfort. There are enough women out there who've had a few babies and now don't mind who watches, that the minority who aren't comfortable shouldn't feel like they HAVE to allow it to facilitate our learning. I watched but didn't do any vaginal exams as a student- I knew I was going to do a specialty that would never involve VEs, and my training has not suffered one bit because of it.

@RedToothBrush Not sure why you addressed my post. I was responding to someone who said it was selfish. I wasn't the one that said it was selfish!

Would it be fair to say that most people would be happy if the doctor/ nurse met you on the way to their room and asked before you entered?

This as the minimum default. But I also think in certain cases there should be a warning that is clear on records that certain patients are not suitable for this and have an expressed wish that they are not asked or they are deemed too vulnerable to be asked.

So two good layers of safeguarding.

That’s why we have signs everywhere in our department and it is written on appointment letters, which also have text in different languages about how you can get the letter translated and request an interpreter.

Signs don't cut it. Because by the time you are in the waiting room, how do you actually action anything meaningful? Its often too late to do anything for that appointment before you might feel ambushed / unable to say no.

There should be a much more proactive engagement on this at GP level or at midwife booking ins BEFORE most people will get to the hospital / are in a vulnerable position.

A and E is an exception - and i would question certain things in that respect because you are getting lots of patients who are perhaps unable to consent.

Trading standards have a set of rules about what is deemed a hard sales practice. These include circumstances where someone is unable to freely walk away. The equivalent is incapacitated in someway in a hospital bed. Or some someone deemed vulnerable.

This doesn't seem to have been carried forward into medical settings - it took enough to challenge bloody Bounty on this score. Why weren't hospitals on the ball with that? For the same reasons that they aren't fully thinking about undue pressure for consent.

The “they’ve got to learn” mantra is getting old and if was applied to other jobs would be ridiculous.

Every job requires learning. Would you be happy going for a haircut and a sullen trainee stands a foot away observing without even acknowledging you? It would make anyone uncomfortable and be weird and creepy and it’s just as creepy and rude in a medical setting.

Would you be happy for that sullen trainee to start cutting your hair with no discussion and when you complain the hairdresser points to a sign about students and says the onus was on you to speak up if you didn’t like it?

Nobody would put up with that.

Every profession and job has trainees. I have never encountered these gormless trainees with awful social skills in any other setting other than medical situations. It’s actually not ok in any setting, professional or social to not even acknowledge someone then proceed to stare at them for 10 minutes.

Would it be fair to say that most people would be happy if the doctor/ nurse met you on the way to their room and asked before you entered?

This is what used to happen and the students were always polite and friendly. I’m not sure why they are now already in the room or why they don’t acknowledge you anymore.

I'm all for students to be able to learn.
and in many instances I agree to students being present or even hands on.

but as redtoothbrush describes, the nhs needs to stop presumed consent and actively ask patients before inviting anyone to observe or participate.

and nhs carers/nurses/dr need to bloody start to read patient information. this is such a fundamental issue!

one of my dc was a student's midwife very first hands on birth.
but it was approached correctly. I was asked before she entered the room and it was made clear that I could refuse at any time. turns out she was lovely and supportive and her supervisor was making sure that she asked for consent for each intervention.

Not wanting to derail the thread but one of the grey areas I've experienced has been around consent for medication, especially related to hospital procedures. I have rarely been given proper information about side effects - just asked do you want something for inflammation / whatever ... and sadly I've experienced some bad side effects as a result.

Likewise when a routine scan showed I'd lost my baby at 12 weeks I was told later that afternoon over the phone 'we've booked you in for surgery on Thurs'. No discussion of options or explanation of why this was the best decision for me or opportunity to ask questions. I didn't give informed consent by any means.

We have signs in all waiting rooms and changing cubicles in my X-ray dept stating we are a teaching dept.
Every member of staff adheres to the ‘ Hello my name is………’ principle along with saying their role. Student and apprentice radiographers also state their role and gain consent from the patient for them to perform the imaging examination. All students are supervised by qualified staff who will take over the examination if required.
There is no issue if a patient prefers not to be imaged by students, but there is only so much they can learn regarding a ‘hands on’ profession by imaging our life-size mannequin.

I owe my life to a student doctor. I had an appointment with my GP because I had blood in my underwear despite having Menopause 10 years previously. The doctor asked if I minded if a student examined me after him. Because he was teaching the student he spent ages going through everything in fine detail. He asked the student what he would do next and the student said send to hospital for tests, very well said the doctor its up to you to arrange it all. It turns out I had very early stage cancer of the uterus. I know some will say I would have gone to hospital anyway but I feel the hour long consultation with the doctor instead of the usual 10 mins made him more thorough. We all have to learn and if we all refuse then how are the future healthcare professionals to be trained.

Unfortunately given the strain of nurses and doctors during the pandemic has seem training almost fast tracked, No medical professional or health service was prepared for this and its not going to change, the amount of staff lost for testing stations etc.

owe my life to a student doctor

This only works if you think your gp is an idiot and wouldn’t have sent you for tests.

Consent or not, student nurses are paying £27k to be used as unpaid labour in hospitals right now. Get angry. At the government that insists it wants to attract more people to the NHS but charges them twice to do it. It's horrific.

@MeredithGreyishblue

Consent or not, student nurses are paying £27k to be used as unpaid labour in hospitals right now. Get angry. At the government that insists it wants to attract more people to the NHS but charges them twice to do it. It's horrific.

What does that have to do with consent? I agree it should be funded as the hours they do on placement would probably equal the fees, but I don't think anyone should feel beholden and like they should consent against their will because its unfair.

@MarbleQueen

owe my life to a student doctor

This only works if you think your gp is an idiot and wouldn’t have sent you for tests.

I agree. It's common knowledge that any vaginal bleeding post menopause must be investigated. No doctor would have ignored that.

@Shinypog no absolutely but the whole consent thing is down to them using students as a workforce. Get angry about all of it. The students are as uncomfortable as you are. It's all wrong.

When I worked in the NHS I didn't love inflicting students on my patients, but I understand they need to observe real consultations-but I was very strict to always talk to the student about their place in proceedings I e to just listen and observe, nothing more - & I always introduced the student to the patient, explained that they were there purely to observe, and I always checked carefully that the patient didn't object - they rarely did in truth but on the odd occasion they did I asked the student to wait outside - so you have been treated by some very unprofessional health staff tbh, in future state your views and if you aren't happy the student(s) should leave - I also think more than one student at a time is not acceptable, I would never have tolerated that

I have had somebody sitting in at pretty much every GP appointment and hospital appointment for the last few years, but I have been asked each time if it is OK.

30+ years ago I took my DC2 to his 6 week check. Somebody at the clinic asked the doctor if this woman could sit in. Nobody told me who she was, let alone asked me. The doctor did every check twice, ignoring me but explaining to the visitor what he was doing.

Understandably the baby started to get distressed. Doctor got stroppy, said he couldn't complete the checks because the baby needed feeding (he didn't), then sat and asked me loads of questions about contraception and whether he was planned

I was furious and put in an official complaint, which my HV backed me up over.

Personally I couldn't give a toss about student doctors , they have to learn somehow . I've had student doctor lead the consultation , I've also had them observe .

Wow that is shocking that they don’t ask you beforehand.
I haven’t experienced this at all and I wouldn’t be comfortable with any of it either. I have had a trainee midwife attend my booking appointment but was asked beforehand if I was ok with her attending. Definitely not on!

I had a student midwife for the birth of my child and to be honest she was the one that was most attentive and caring towards me as it was still new and the reasons for going into a caring profession was still there in them unlike so many that have been in for so long you are just a name and number to get in and out asap.

But I was asked if I was ok with this. I do agree you should be asked but I'm guessing so many people say no they try and get round it by doing things this way. It ok if you are ok standing your grounds when your not comfortable but there are so many that just won't have the confidence yo say anything

@TinselTinsel

Personally I couldn't give a toss about student doctors , they have to learn somehow . I've had student doctor lead the consultation , I've also had them observe .

Does this mean "I don’t care, even if I'm not asked first whether I mind, and even when it's a student practicing a treatment on me without me being asked first"?

You're happy to be a guinea pig without even knowing you're a guinea pig? How many un-introduced strangers are you happy to have there?

When I worked in the NHS I didn't love inflicting students on my patients, but I understand they need to observe real consultations-but I was very strict to always talk to the student about their place in proceedings I e to just listen and observe, nothing more - & I always introduced the student to the patient, explained that they were there purely to observe, and I always checked carefully that the patient didn't object - they rarely did in truth but on the odd occasion they did I asked the student to wait outside - so you have been treated by some very unprofessional health staff tbh

The staff have treated me exactly like you treated your patients. Your student was already in the room and you told the patient the student was going to observe. You put the patient in an awkward position and I’m quite certain many would have felt too uncomfortable to say anything.

Why do you tell students just to listen and observe? Do you realise how weird and inappropriate it is to have someone sitting staring at you without saying anything for the duration of an appointment?