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 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

How awful it put you off going back. The staring is awful and totally inappropriate.

@ParkingDiagram

You’ve clearly been unlucky to have so many events of students observing. I’ve somehow managed to never once have that happen but it very much depends on the situation.

Dental - no problem.
Gynae - no way.
GP appointment - depends on topic but mostly ok.

But how would people train if all women refused to have a student in a gynae appointment?

I wonder if the reason they have started presenting it as a given rather than asking for consent at the beginning Is because so many people were then saying no. And if everyone says no, then we are a bit stuffed, aren’t we?

But just from this thread, there are many women who are either happy, or feel it is their duty, to have students in a gynae appointment. And all kudos to them.

Funny, I've never heard much about men being told/asked in such a way as to make the expected outcome clear, about having an observer in a prostate exam or vasectomy. Perhaps the expectation just isn't quite there yet that they should, of course put everybody else's wants and needs before their own when they seek quite a personal medical treatment?

We're the soft targets. As per fucking usual.

@Holly60 - did you read the posts from @mbosnz and @SarcasticIntrovert on the previous page? It's a much more nuanced issue.

And even if it is 'difficult', meaningful and informed consent is a DUTY upon medical practitioners. Not a nice to have, until it gets all a bit difficult. So no, presenting it as a given is not appropriate, regardless.

Anymore than having an observer without consent during a rape kit.

@MarbleQueen - any doctor with an ounce of wit / compassion would have realised that having a student observe was completely inappropriate.

I have no clue how students in this field are trained but i'd say informed consent from people with mental health difficulties is especially problematic.

If I had been seeing this doctor for a period of time and had built up a relationship than maybe I could just about understand it.

Also to @SomersetS - maybe show this thread to your DD. It may help them develop a more nuanced view of informed consent than you have.

Just remembered another example of when this happened to me.

I was having growth scans for DC1 and I turned up for my 34 week scan and was sitting in the waiting room when the radiographer came and got me, and she said "this is Dr Smith who is also going to be having a look at your baby today", so I said "oh, OK, hello". I got a bit concerned that something was wrong that the doctor needed to be there.

Scan started, Dr Smith was doing the scan with the wand and she and the radiographer were talking to each other in very clinical language, and then I remember a conversation going something like:

Rad: yes, just there
Dr: about there?
Rad: Hmm.
Dr: No, that's not great, is it.
Rad: No.
Dr: It's not very round is it?
Rad: No, I think you're right.

And DH and I sat there staring at each other in fear, with no idea what was wrong, but knowing that it didn't sound good and nobody was speaking to us. Then the Dr said goodbye and left and the radiographer printed out some photos and sent us on our way. That was it.

DH and I left utterly baffled, and then I called my mum (ex nurse) in a bit of a state and it was only then that we worked out that the obstetrician doctor was probably learning to do some scanning as part of their consultancy training or something. My mum was very cross with me for not saying "Em, excuse me, but why is the doctor here? Is there something wrong? Can someone please speak to me?". Easier said than done when you're anxious and unsure what is happening.

(the same doctor appeared on a ward round in the labour suite 8 weeks later with the consultant and loads of junior doctors, after DC1's emergency birth. She was very nice then, and did speak to me).

[quote Brainstorm21]**@Holly60* - did you read the posts from @mbosnz and @SarcasticIntrovert* on the previous page? It's a much more nuanced issue.[/quote]
I was replying more to the PP who said she wouldn’t have a student in a gynae appointment. I agree it should be more nuanced which is why I was shocked she said this. If all women refused to have a student in any of their gynaecology appointments we’d be in a predicament.

But I agree that women must have the right to say no if they really feel it is inappropriate.

Um, the predicament is that of the teachers and the students. That is a 'them problem'.

Assuming that women will offer themselves up to be unpaid mannequins who don't feel they have the right to say no, or the power to say no, is not the answer.

@mbosnz

Um, the predicament is that of the teachers and the students. That is a 'them problem'.

Assuming that women will offer themselves up to be unpaid mannequins who don't feel they have the right to say no, or the power to say no, is not the answer.

Does it not become our problem when there are no specialists in women’s health??

@Holly60 HCPs on this thread have repeatedly reported that only very very rarely do people decline, read the thread

@Brainstorm21 I don’t know about that but many medical procedures and surgeries can be watched on video so that can be a learning tool

@Holly60 Right now, this is the problem. So we should sort this out before worrying about a theoretical problem that won’t ever happen.

[quote AutomaticMoon]@Holly60 HCPs on this thread have repeatedly reported that only very very rarely do people decline, read the thread[/quote]
I’m not disputing that. In fact it doesn’t surprise me in the slightest. What did surprise me was the PP who stated she wouldn’t allow a student in any of her gynae appointments. Likewise I’m surprised that another poster thinks that having specialists trained in women’s health is a ‘them’ problem.

In my experience the vast majority of women understand the imperative to have highly trained gynaecology specialists.

In short, I agree with you

I’m not sure whether the culture of this country is contributing to this problem, there seem to be many people who feel that all womens’ bodies are automatically a training tool.

[quote AutomaticMoon]@Brainstorm21 I don’t know about that but many medical procedures and surgeries can be watched on video so that can be a learning tool[/quote]
Interesting. If I had to choose between a doctor who had trained by working with patients in person and in close partnerships with other highly qualified doctors or a doctor who had trained by watching videos of procedures, I know who I would choose!

@Holly60 Why does it surprise you so much? Did you think she might have trauma from being raped or sexually abused as a child and that pelvic exams are triggering and nigh on impossible for some people to do even without extra people present?!?!

@AutomaticMoon

I’m not sure whether the culture of this country is contributing to this problem, there seem to be many people who feel that all womens’ bodies are automatically a training tool.

If having a trainee in the room whilst I have a gynae appointment means my daughter or grand daughters get the very best care available to them in the future, I’ll do it, every single time.

If we didn't have students, however, there would be no future practitioners....

I live in wales and haven’t noticed this. But I think it’s really worrying. Like you have said the student should be actively engaging with issues of consent and the patient should never be made to feel bad for saying no.
In the past when asked I’ve mostly said yes, but not when there was a crowd of students and it was intimate. Another time a student examined inside my ears and was too rough but was really very apologetic most students have actively thanked me for allowing them to be present and I appreciated that. But obviously not all have been properly prepared.

[quote AutomaticMoon]@Holly60 Why does it surprise you so much? Did you think she might have trauma from being raped or sexually abused as a child and that pelvic exams are triggering and nigh on impossible for some people to do even without extra people present?!?![/quote]
The previous PP did not give a reason so it would be total conjecture to speculate on WHY she said she wouldn’t have a trainee in her gynae appointments.

If this is the case for you I can understand why even this discussion is triggering. However that doesn’t mean I’m wrong in believing that medical trainees need to be able to learn on the job, the same as millions of other people in all sorts of professions. More so, quite frankly. I don’t want a poorly trained doctor treating me!

@Wnkingawalrus

Interested how you expect students to learn, OP.

Would you prefer the newly qualified person doing your smear test had never even observed the procedure?

Obviously they have to learn, but if it's a procedure you're nervous (or in my case, likely terrified) about, then having any observer there will not help you.

Hopefully there's enough willing patients about for it not to be a problem.

I wonder if the reason they have started presenting it as a given rather than asking for consent at the beginning Is because so many people were then saying no. And if everyone says no, then we are a bit stuffed, aren’t we?

Yikes, imagine if this was considered acceptable practice in other aspects of "consent": You can't convince anyone to agree on advance, so just don't ask her and carry on with what you want to do to her body, so you get what you need from her.

Anyway, long-term, doctors are shooting themselves in the foot here. If women don't feel like their dignity is being protected/considered in appointments generally (particularly gynae related), then women are going to be more apprehensive about the appointment and less trusting of the doctor. Therefore they will also be less willing to add to that already unnecessarily high discomfort by adding a student or two into the mix.

If I was spoken to in advance (eg at booking in or similar) and informed that there was a student/ trainee on but it was up to me whether I was OK with them being there, or I was offered to think about it for a few minutes and not put on the spot, then I might be more inclined to say yes. If the junior dr/med student also addressed me respectfully, introduced themselves, and also made it clear that they too were conscious of my dignity then that too would help put me at ease with the situation.

If doctors are not able to put their female gynae patients at ease then that is very much a problem with the doctors, not their vulnerable patients.

@m1shap3

If we didn't have students, however, there would be no future practitioners....

Part of being a medical student is learning how to treat vulnerable patients, protect their dignity, and be able to gain free consent.

After sending in an econsult to my gp practice a few days ago, I was told I'd receive a phone call from a GP the next day. Instead I received a text that they had made an appointment for me (the following morning when I was unavailable at a further away but part of their "group" practice) and it stated that I would be seeing their medical students and then a named doctor.