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.

Obviously I had to call to cancel and try to rearrange but there was definitely no requesting consent, just stating that I would see the students before I would see a doctor.

I remember as a preteen child (so nearly 50 years ago) having a flock of medical students clustered around while I was having an assessment (almost undressed, don't know why) due to long term migraines. Wasn't asked of course, but I felt a bit ill and spaced out so didn't care.

As they drifted off, one young woman student hung back and said said "I don't think this child is very well" and peered closely at a developing rash no one else seemed to have noticed, including the consultant. She quietly told my mother she thought I needed to see a doctor ASAP (!!!!) and squeezed my hand. She was lovely.

GP called out the next day. I had scarlet fever, quite unusual in that period. I've never forgotten her and often thought what a wonderful doctor she must have made. I've consequently always agreed to the presence of students, although of course there should be consent on all occasions and it should not be pressurised.

@Spongeboob Another PP was told recently on the phone that if she wants a face to face appointment she’d have to allow a student to observe otherwise she wouldn’t get an appointment. The BMA rule that was posted up thread seems at odds with this presumption of consent.

I think you've been 'unlucky' to have that many students observe
I've had it a few times and don't care usually as its never ben anything I'm personally concerned about and everyone has to learn.

Having said that, if they are actually doing any treatments I'd definitely want to know beforehand and I'd like to have the opportunity to refuse consent to being observed if I felt like it too

[quote AutomaticMoon]@Spongeboob Another PP was told recently on the phone that if she wants a face to face appointment she’d have to allow a student to observe otherwise she wouldn’t get an appointment. The BMA rule that was posted up thread seems at odds with this presumption of consent.[/quote]
That's not a presumption of consent, that's blackmail!

Obviously there's massive work that needs to be done on this, but I think the replies demonstrate some of the problem. Some people want forms, some think forms aren't enough. Some want asked ahead of time, some want to see the student in question and then make up their mind. And then if the student is allowed in, they're being slated for watching intently. I'm not sure what else they should be doing when observing a consultation!

Just read this out to GP husband, who is pretty shocked. This should NEVER happen. You should ALWAYS be asked whether you consent to a student being in the room. Also, the door should be either locked or a ‘Do Not Enter’ sign displayed whenever an intimate examination is taking place.
Please do report this to PALS - it sounds like something has gone very wrong within your trust. The NHS takes this sort of thing seriously and the trust can even lose educational funding for not following procedures for things like consent.

And then if the student is allowed in, they're being slated for watching intently. I'm not sure what else they should be doing when observing a consultation!

I know this is really out there, but how about a basic Hello and introducing themselves?

In what other circumstances is it ok to stare intently at someone for 10 minutes without saying a word? When did that become ok? Why are people arguing that it’s just too much to expect medical students to have basic courtesy?

If you don’t realise how inappropriate and weird it is to silently stare at someone for ten minutes try it out on a strangers and come back and tell us what reaction you get.

I don't blame you, they should ask, I had the contraceptive implant removed and a new one put in, in 2020. There was a student, but I was asked if it was OK if they observed, I was OK with that.
But I wouldn't be happy having a male, student in the room, when talking about female problems. They should definitely, ask your permission with that. As I would feel comfortable, talking to a male Doctor either, I know they know about these issues, but I thought they had to ask, if you would like a female nurse in.
I have had a student take my blood, when I gave blood, but this was with consent and before covid. I am going to the dentist on Monday, so I will see if I encounter a student there.

Can anyone involved in dentistry explain why there are now students at the dentists?

Several posters have accused me of lying about this but other posters have confirmed their dentist now has posters up informing them there will be students present.

I am near a large dental school and if you want to be treated by a student you go there, but I have never experienced them in the dentists.

I’m really pissed off that the dentist actively lied to me about them only watching. I don’t feel I can complain in case I get kicked out of the practice.

[quote AutomaticMoon]@Spongeboob Another PP was told recently on the phone that if she wants a face to face appointment she’d have to allow a student to observe otherwise she wouldn’t get an appointment. The BMA rule that was posted up thread seems at odds with this presumption of consent.[/quote]
You are absoluetely not allowed to make appointments conditional on 'compliant' behaviour.

Thats definitely one worthy of a formal complaint. If its been written down, then they would be toast.

@PearPickingPorky Oh yeah, that is blackmail, thank you for pointing this out, duh! I knew it was even worse than presumption 😞

@MarbleQueen

And then if the student is allowed in, they're being slated for watching intently. I'm not sure what else they should be doing when observing a consultation!

I know this is really out there, but how about a basic Hello and introducing themselves?

In what other circumstances is it ok to stare intently at someone for 10 minutes without saying a word? When did that become ok? Why are people arguing that it’s just too much to expect medical students to have basic courtesy?

If you don’t realise how inappropriate and weird it is to silently stare at someone for ten minutes try it out on a strangers and come back and tell us what reaction you get.

This is a really good point. Some of the students we have with us are dire. We see a lot of new students coming in who are fresh out of school/college and lack any basic social skills, especially when talking with adults. Our department now make it mandatory that students shadow the receptionists for a week, then the departmental assistants, before having clinical contact with patients. It helps a bit. Unfortunately if we have a student with us they are in the room when the patient arrives. I always get my clinic assistant to ask the patient at the door, before closing if they are happy for the student to stay in the room. It's the only way around it. I then introduce us all which usually forces the students to say hello as well. They actually get asses on their interaction with patients. I will always have a female assistant with me as well rather than a male.

If it’s “no big deal” and “they need to learn” let them stick their fingers into each other. I am an abuse survivor and tend to freeze under stress, so am easy to coerce into agreeing to things I’m not comfortable with.

Even non-intimate exams are still uncomfortable for me if I’m outnumbered. I find it difficult to ask the questions I need to ask to understand or to self-advocate if I feel like the interaction is focussed on the student, not on my medical concerns.

I’ve even had it happen at a private physiotherapist. I put a stop to that quickly - physio is not something I enjoy having an audience for, nor be subject to a running commentary on my physique, health & posture.

Whenever I've needed a referral it's always to a large London teaching hospital and there have always been students present. How they have interacted with me has depended on the scenario - e.g. I had a non serious form of skin cancer removed, was quite relaxed about that appointment, didn't mind that there were about 6 of them and that the consultant was asking them questions to test their knowledge cos I felt pretty comfortable about the appointment anyway.

Most recently I went in to have my coil replaced, male consultant with a female student, that's a much more vulnerable scenario and tbh I would not really have been happy with a male consultant and a male student (I realise that every consultant was at one point a student!). Basically I think the more stressful the context of the appointment for an individual, the more the presence of someone learning can be unhelpful. As it was, I was happy that she held my hand, but there's no way I would have wanted a twenty something lad do that!

@MarbleQueen

And then if the student is allowed in, they're being slated for watching intently. I'm not sure what else they should be doing when observing a consultation!

I know this is really out there, but how about a basic Hello and introducing themselves?

In what other circumstances is it ok to stare intently at someone for 10 minutes without saying a word? When did that become ok? Why are people arguing that it’s just too much to expect medical students to have basic courtesy?

If you don’t realise how inappropriate and weird it is to silently stare at someone for ten minutes try it out on a strangers and come back and tell us what reaction you get.

Especially if the patient is undressed/in pain.

A "Hi I'm X, thanks so much for letting me attend. I'm just observing today so do let me know if you'd like me to step back or leave at any point' would go a long way towards putting the patient at ease and making them feel that they still have bodily autonomy.

I’m usually ok accepting a student but if I had to have lots of intimate examinations and dealing with cancer too I too would be reluctant

@SomersetS

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.

How arrogant would you have to be to think it’s the “duty” of a patient to provide practical experience for a medical student.

They are a patient. Their medical needs trump a student’s need for practical experience every time.

And for some patients, which you would know if you’d read their posts on this thread, have felt compelled to say yes to a student being present even when they’re not happy about it, especially when the student is already in the room. It’s got nothing to do with being “brave” ffs.

I always say hello to a student ask their name Which university they're from to put them at ease. They're experiencing many things new to them. Sat with a fourth year at Xmas friends son. The week before he was expected to flit between hospitals attending different specialities . He said that he had to get through traffic jams worried he would be late getting from one hospital to the next. He looked like hell had put on weight bad eating had spots and big bags under his eyes. He's a compassionate young man has been since he was a little boy.

OP, i am sorry to hear of your experiences,
I think I have been lucky!
22 years ago, I was in labor and was asked if I minded having a male student midwife assist my labor, I didn't mind at all, it was my third birth, and I have to say was my best midwife. The birth was his last one to be assisted.
11 years ago my darling mother was dying from an aggressive cancer - mesothelioma -and our GP asked her if she would come to surgery to meet with students, Mums cancer had almost been missed and GP was determined that no students would miss it . Mum was very happy to do this.
I have been an inpatient several times in the last few years, and maybe I am lucky that our trust are very hot on the 'Hello My Name is' scheme. On my last admission, a very sweet student doctor, who had been introduced to me when consultant did his rounds popped back and asked if he could take a full case history.
It didn't worry me at all.. as students have to learn somewhere... and to be honest, if they don't ask they don't learn!

The raise the heckles post says rather more than it should.

It says that the needs of the student are the central priority and that patients should serve them.

It has a disregard for anxiety being a medical condition and instead throws the shite about 'bravery' about in order to try and shame patients.

All because darling child might not get the prime education and opportunity see the textbook cases they want to observe for their portfolio.

The whole thing dehumanises patients and is utterly disrespectful to their needs. It reduces them to little more than a body rather than an individual.

And do not get me started on the crap about how patient should do x to stop it happening when there are numerous posters saying they aren't being given the opportunity to or are outright ignored or blackmailed if they quest it.

Patients should be the central focus. Not doctors or nurses.

This is about trust. If people don't feel comfortable with it, then they have a trust problem or a dignity issue of some kind going on. HCPs would instantly learn a lot about the background to a patient by thinking about why a patient is unhappy or might refuse to have an observer. They might actually learn as much as than a physical examination might reveal....

To all complaining about consent do you realise it means to allowing procedures as well as students. For example if you go to see your GP because of some infection and he says 'I see you haven't had your flu vaccine , I'll do it now. You can refuse to have it if you don't want it. I'm type 2 diabetic and the nurse specialist at my GP surgery does my checks eg BP, foot health etc and then says hop on the scales , I always refuse because I don't want to know what I weigh and I certainly don't want there to be a record of it in my notes . Most people are like sheep and do what is requested of them .
Even in hospital consent can be implied consent . You get admitted , the nurse asks to check your BP. You agree to it thus giving implied consent . Every nurse might ask permission to do it every time but some might not as they can see by your charts that you haven't refused so far therefore 'implied consent'

Everytime there has been a student present I have been asked if I'm OK with it. I usually say it's fine as it has never been during something really personal. I think that is awful they didn't ask for consent when having your baby and it meant you didn't have any support because the midwife was helping the student. I would make a formal complaint.

@RedToothBrush In care work there’s something called Person Centred Care and it’s quite a big deal. I don’t understand how it doesn’t exist in the NHS. The NHS seems to need patients to protect it instead of vice versa.

I’m appalled at what you’ve gone through OP. Entirely unacceptable. I’m also appalled at the number of posters here who seem to need to tell you how it wouldn’t bother them and to ask you how you expect medical staff to learn. Well clearly that answers their own question.

You should not have been put in this position even once and if I were you I’d complain now, otherwise your hospital won’t learn about consent, proper treatment of patient privacy and the need for women to be able to relax for certain procedures.