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.

At my last eye clinic appointment the doctor asked if I was okay with having three other doctors present whilst he examined my eyes. I agreed to this and each doctor had a look at my eyes and were polite and thanked me for allowing them to do that.

Patients should always be treated with respect and consent sought for everything that happens, including permission for students to be present.

"My name is Adam, is it ok if I observe?" would be so much better than "My name is Adam. I'll be observing. Is that ok?"

I don't actually tell Adam (students) exactly what to say, just to introduce themselves and to ask the patient if it's okay with them if they observe.

We actually give patients a short questionnaire to fill out while they are waiting, so tomorrow I'm going to add on something about being happy for a student to potentially be present during consultation, with a yes or no tick box, and leave it at that.

As in, I won't be sending students out to introduce themselves and ask patients in the waiting room. I'll introduce them when the patient comes in, as long as they've ticked yes on the questionnaire.

I’m wondering what is going on with all the A Student Saved My Life story’s. If a student had to step in because the doctor didn’t notice life threatening problems then that is very serious and should have warranted an official complaint. I’m wondering what action people took about these utterly incompetent professionals who missed serious issues.

Im inclined to think it’s a type of cognitive dissonance. You go to the gp worried and upset with an intimate issue and instead of having one distressing internal examination by a man you have two. You could be upset about that or you could tell yourself thank god the student was there because he saved your life.

We actually give patients a short questionnaire to fill out while they are waiting, so tomorrow I'm going to add on something about being happy for a student to potentially be present during consultation, with a yes or no tick box, and leave it at that

This is a really positive and solves the problem.

They need to learn but sounds like you've had it happen too much. After my first c section I was super vulnerable and in pain and trying to sleep. Suddenly the curtain whipped open to a dozen students and a doctor explaining all my details. They definitely need to ask consent and be more tactful.

I work in med ed and absolutely the clinical supervisor should be actively seeking consent. It's not enough to have a sign informing you students are present.

There's another thread about something slightly different, entitled 'I am not Your Teachable Moment'. I think perhaps it needs to be remembered that when a person seeks medical treatment, first and foremost, and quite rightly so, their priority is getting medically treated, as quickly, as non-traumatically, and as effectively as possible. Not the education of aspiring medical staff. Patients aren't being paid to be guinea pigs. (I say this as the grand-daughter of a woman who was a guinea pig for a really rather famous plastic surgeon during WWII, so I do have some understanding of the hellish - and I mean hellish, sacrifices of those who have sacrificed so much in the past. My Granny was a far better woman than I. As was my Mum.)

But that kind of strength, and generosity should not be assumed of patients, nor taken for granted.

@Madjakelmum

Really uncalled for. Obviously permission should be asked

Your a complete dick

Maybe. But I’m a dick who understands consent.

@MarbleQueen

We actually give patients a short questionnaire to fill out while they are waiting, so tomorrow I'm going to add on something about being happy for a student to potentially be present during consultation, with a yes or no tick box, and leave it at that

This is a really positive and solves the problem.

I disagree that it solves the problem. it doesn't say who would like to observe, their sex, their stage of training.

I'm generally happy let students sit in. but not everyone. or everytime.
and I would certainly want the right and opportunity to withdraw consdnt at any time.

Your post has raised my hackles.
I'm a parent of a 3rd year medical student and I can assure he/she is neither gormless or rude. They are excited to be on placement, desperate to learn, see as many different procedures, problems as possible to become the best doctor (in the NHS) to help you and your family in future.
If you don't feel it's your duty to assist in this process whenever you can & be brave enough to say no thank you when its important to you, face to face to a student (who I know is fully expecting you may not consent and will then hide in the corridor for your ten mins) or ask at reception/ email or letter to never allow students to attend your consultation.

I've never objected to a student being present, and have consented to them doing some procedures on me when asked. But had I been TOLD, not asked, and not put at ease during an uncomfortable procedure or appointment then I wouldn't be happy either.

I haven't read the full thread but notice you did ask about people saying students saved their lives. A student didn't save my life, as such, but did discover I have a condition that wouldn't have been discovered had she not been scanning me that day. I went for a pelvis and kidney ultrasound due to issues with endometriosis. They asked if the student could have a go and the qualified technician check afterwards. I wasn't in a hurry so agreed. The student did the scan (and at this point I should point out I didn't agree to them scanning anywhere else) but scanned my liver too, whether accidentally or for practice I dont know. Upon doing this she found that I have a liver full of benign tumours which could rupture and kill me or turn to cancer. As a result I am know regularly monitored by liver specialists and the student could have potentially saved my life. So whilst they didn't get my consent I am glad they did the scan. Swings and roundabouts I guess.

@GrapefruitPink

Wow you've had a lot! Only happened to me once at a MW appointment. I was asked as I walked in if it was ok, I said yes. My MW done what she needed to, listened to heartbeat and felt where baby was. She asked if it was ok for the student to have a go, I said yeah.

But I would always agree tbh. We all have to learn our jobs.

Same, the same student was with my midwife every time, and every time she asked if it was ok for her to be present. MW spoke to me initially, then confirmed with the student what she was looking for/at. She asked if the student could then carry out the same checks - sure. I had surgery a few years ago and my surgeon asked whether he could share my case with students, I said OK, then he proceeded to bring in 4 very young looking males to have a gander, all while I was naked under the papery gown but I'd consented. You should always be asked IMO

I've always been asked for consent I usually consent but if I had a problem with them being there I would request that they left whether I was asked or not The nurse who said you were being silly wasn't very professional and had I been told that you can be sure I would have reported that

There is a sign in the waiting room at my gp's explaining they are a teaching practice so both students and trainees (qualified drs or nurses but in training for general practice) you are instructed to let the practice manager if you are not comfortable with them being present. The hospital is a major teaching hospital therefore you expect students, they have to learn. My dd2 was delivered by a student, her first birth (she had observed before) and she was amazing actually, so confident, I was informed that she would be present, they need to learn

I've had students for every single midwife and health visitor appointment and also had students during my 2 week stay in hospital after birth. All were very respectful and o was asked every single Time if it was okay for them to be there. Sorry this has not been the case for
You, OP

Of course they have to learn but in my experience years ago you were asked beforehand of it was ok.
Something seems to have changed.
The nurse saying you had a problem was way out of order imo.

Your post has raised my hackles.
I'm a parent of a 3rd year medical student and I can assure he/she is neither gormless or rude

Why do you think a complaint about OTHER students is anything to do with your adult child? Do you generally hear complaints about other people and personalise them?

Utterly ridiculous.

It's nobody's duty to allow people to sit in on their medical consultations and procedures if they are not comfortable with it. They are there first and foremost, to seek medical advice and practice, for their own wellbeing, not to be somebody else's 'teachable moment'. I say this as a mother of a person who is likely to go into training as a health practitioner (fingers, eyes, legs and toes crossed). A person seeking medical advice or procedure is already potentially in a bit of a state. More of a state than the student who might be denied their 'teachable moment'.

Signage works if you can read it. I.e. if you know the practices procedures, you have sight, you can read, and you can read the language it's in. And that's also assuming you haven't further issues like selective mutism, related trauma, gender or cultural issues that mean you find it really incredibly bloody hard to believe you have the right to say no, let alone the strength of voice to say no.

@MarbleQueen - I've only read your comments not the full thread but it seems like you are being flamed from all directions.

I have a story which illustrates your point exactly. As a 20 year old I had various mental health issues which caused me to drop out of university due to stress and self harm.

My parents finally got me a private appointment with a clinical psychologist (maybe not correct term but whatever not the point of the story).

At the appointment I was informed (not asked) that a student would be observing. Said student neglected to introduce themselves and stared at me like a lab rat the entire time including when main doctor left the room for a moment.

I felt extremely uncomfortable and never went back for a 2nd appointment and the issues I experienced have never been addressed 20 years on.

For the doctor it may have been a small thing to say ask for consent correctly in the manner you have outlined but for me it was massive.

You know what my issue was? Social anxiety! You couldn't make it up 😀

I am a nurse and often have students. I always ask my patients if it is ok for them to be present. I have even phoned ahead of their appointment and ask to save them feeling like they can't say no if already in the room.

There are several issues at play here. First the patient should clearly be aware of who will be present in the room and what their role is. This should be information given in a non confrontational situation (with due regard for the fact that some people may feel very intimidated by even being asked, never mind being asked while the student(s) concerned are already present. Also this could be an excellent lesson on how medical professionals actually speak to their patients. I've had a very mixed experience of feeling like I have had the best possible care/someone that is listening to me/someone that understands me. Vs medical professionals who ask the same question repeatedly yet fail to grasp the answer, bark questions at you as if you're in an interrogation, be totally prepared to release you without any explanation as to what they think has happened/is wrong with you etc. Some people who have commented have really felt involved with their treatments as a result of having students or trainees there but others have felt left out and less informed. Actually learning to speak to patients is a vital role of health professionals. Also to anyone suggesting that anyone who doesn't consent to students being present are in some way responsible for the downfall of medical training this is an awful thing to alledge. Everyone has a different tolerance level especially where medical procedures are concerned. Having blood taken isn't particularly intimate or sensitive but for some it can be really traumatic. Smear tests can be viewed as horrendous or just one of those things. Respect needs to be given for each individual and what they consent to and actually these events can all be made a bit more tolerable if the professionals and/or trainees involved take their time to recognise the person as a human being who deserves to be involved in the decisions and information about their own body.

I have always been asked if I consent when a student is present.