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.

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

I find it's a culture problem in the NHS. We're supposed to be eternally grateful for the fact that we're being seen and to humbly defer to them over every aspect of our health.

@BarrowInFurnessRailwayStation Sadly, I see this too

Some people have taken offence to my comments about staring and I think it’s because they don’t understand.

If I was having stitches in my hand it’s quite understandable that a trainee would have to get quite close and watch carefully. Same goes for other procedures.That’s very different to a student sitting in a corner staring intently at you across the room for 10 minutes without saying a word.

In the situation where 3 students were brought in without my consent that meant there was now 4 students stood silently staring at me. I was extremely upset by the procedure, it was painful and frightening and I’m no baby.

The consultant asked me afterwards if I had any questions and i did not feel comfortable asking questions with an audience of 4 silent staring people. None of them spoke at any point.I don’t understand what the students learned as they didn’t actually watch anything in reality because the procedure was very delicate and only the doctor could see with the use of a magnifying thing.

If I had been asked about a student I probably would have agreed. If they were friendly I probably would have agreed to them having a look. I don’t understand what they were meant to have seen across the room.They did not watch the procedure as they logically could not because of the nature of it. They were watching me, staring intently at my face. The doctor did not acknowledge them at any point at all.

This is very different experience than having a student who acknowledges you and who might ask questions or ask to examine you in some way. They are engaged and involved and I personally don’t object to these students.

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

Do you know what, of all the reply’s this one has pissed me off the most. Dam right I don’t feel it’s my duty to allow an endless stream of gormless trainees or students to mess with me. Damn right I don’t think it’s my duty to accept my dentist lying to me and allowing a student to mess with me who’s so clumsy and nervous she’s accidentally clanking something metal against my front teeth with her shaking hands. Why should I pay for professional treatment and get a trainee? I could have gone to the dental school and had it done for free!

If you are so concerned about your offspring getting experience then pop along on the back of unicorn to the hospital and volunteer. Let a load of gormless students stare at your vagina while a painful procedure is done SIX TIMES for the benefit of people like your offspring like a poor woman on here was expected to do.

Go and get your arse prodded repeatedly so the students can learn and let them practice colonoscopys on you. Don’t worry because the students are really excited to learn. When you’ve done that go and volunteer for repeated breast exams by clumsy students who examine you so roughly it leaves bruises like another poor woman on here.

If you don’t feel it’s your duty to assist in this process you’re a bad person. Obviously.

At my last appointment the door was open because of covid I wish they had asked if ok. I get there was me, student and Dr in very small room and open to a corridor rather than waiting room. But was going though personal health information. The Dr was a bit wooden at least the student seemed sweet.

If you don’t want a med student to take an active part (or even a passive part) in your procedure or appointment, then you could tell your team that you aren’t comfortable with them.

I’ve had some pretty gnarly procedures (at a teaching hospital), whilst I am always happy to have a student midwife, nurse or doctor present, there were plenty of signs around staying if you aren’t happy to have students in your appointment you could tell your medical team.

I do agree that you should be asked if you’re ok with having students present. Personally, I’ve always been happy to give consent. Most of the students at the local teaching hospital were postgrads (alas the hospital was absorbed into another & closed), but there were occasional 18/19 year old (particularly nursing) students on the wards & in out patient appointments. Regardless of their speciality or role, I’ve found all students respectful & courteous.

I do come from a background of teaching though, so I can appreciate the benefit of real life teaching opportunities. If you’re not happy with it, speak up.

Unlike the pp with raised hackles, mine are not because the descriptions of bad practice on the thread don't apply to my family member, she's compassionate and kind and treats her patients with kindness and respect rather than entitled contempt.

I don't understand why someone's hackles would be raised if their kid doesn't display the attitude and behaviour being discussed. It would be like me taking comments on a thread about aggressive police officers and then applying them to my non aggressive police officer child and taking it personally.

I wonder if having a student present at a GP visit affects the outcome. A GP at my surgery made a stupid and possibly life threatening desision. I wondered if he stuck to the rules or guidelines as she was present instead of doing the obviously right and logical thing going by my symptoms. I ended up in A and E next day in a life threatening situation. I regret not arguing with him at the time but I was too ill to.

I'm fine with it almost all the time, no matter the intimacy of the medical situation. Times I'm not fine with it would be more to do with if I was feeling somewhat fragile at that time. I do agree that it is very important that students are able to learn. I want them to learn. I sometimes deliberately raise (relevant) things with the main medical practitioner specifically so that they can learn (I have multiple long term health conditions).

BUT I will NOT put up with a lack of asking for, and obtaining without pressure, appropriate consent. I may allow them to stay, or I may not, but I will jolly well complain at some point, at the time or later, depending). Because others may not feel able to do so and I want to try to effect a change to how it should be.

And no, btw, NHS medics & allied professionals: you do not "consent people". You "ask for their consent" and give them enough time and information to give it (or not as the case may be), allowing for the urgency of the situation obviously. For anything that requires consent. No matter how busy you are. It's fundamental.

OP YANBU.

I find it's a culture problem in the NHS. We're supposed to be eternally grateful for the fact that we're being seen and to humbly defer to them over every aspect of our health.

While I don't find this to be the case every time, I do agree that this does seem to be the case too often, and does seem to be getting worse.

@Itsalmostanaccessory

I was induced when having my second child. The person who was about to give me the pessary popped her head in and asked if it would be OK for a student to observe. I said yes. She then came through the curtain and 6 of them walked in behind her. I felt like I couldnt say no after saying yes to one person so has to have my legs open with these 6 students all having a good look and having it all explained to them

My Dad had similar. During his radiotherapy treatment for testicular cancer he went to the hospital one time and was about to be examined first. He was asked if a student could be present and. like you, said yes, only for a roomful to appear - he was mortified but felt he had said yes so couldn't refuse and was too embarrassed to say no then anyway!

I’m a qualified nurse and practice assessor so I have many students observing me. I have one student allocated at a time and it’s not all the time.

My take on your experiences is that you have been treated disgustingly! I would 100% report this behaviour through PALS because how dare they try to do a VE when there is no therapeutic benefit and you should never just walk in to an appointment (whatever it is) and just see a student sitting there. It’s one thing to walk in and be asked if it’s ok each time and for them to leave if it’s not ok with you, but it’s quite another to make you feel uncomfortable if you ask them to leave or to just walk in to see them sitting there like they have any right.

I ask my patients (usually Over the phone before the appointment) if they mind my student being there. Rarely do people say no but sometimes they do and it’s FINE with me and should be like this everywhere in practice.

Yea students have to learn, and they will because most people don’t mind but if you do mind say no! I wouldn’t want a student observing anything private. It’s hard enough as it is without being watched! They also should talk to you not the student all the way through. I usually do the medical bit and talk to the patient and then just briefly explain little bits to the student but involve the patient during this time so eg ‘I’m going to take this measurement so we can assess x,y and z’. After each patient I reflect with the student so they understand everything clearly and get them to do my admin! Because having a student is time consuming when we’re busy as it is.

Please report this. It is not ok!

Just to add with regard to me not wanting a student to watch anything private I’m referring to my own care and also if they say ‘a student’ it should be one so always exercise your right to say no! It’s your body! Your private life and your choice

Absolutely YANBU!! Years ago when I had my otoplasty and I obviously had my ears visibly bandaged, 2 med students asked me: oh, what kind of surgery did you have? I told them I had a nose job and they happily went away. I often wonders if they're doctors now... 😃

@IrritableOwlSyndrome

Unlike the pp with raised hackles, mine are not because the descriptions of bad practice on the thread don't apply to my family member, she's compassionate and kind and treats her patients with kindness and respect rather than entitled contempt.

I don't understand why someone's hackles would be raised if their kid doesn't display the attitude and behaviour being discussed. It would be like me taking comments on a thread about aggressive police officers and then applying them to my non aggressive police officer child and taking it personally.

Realistically that poster has idea what their child is doing when observing anyway. They aren't with them to witness it. Lots of students will come home and talk excitedly about what they have seen or been doing. It doesn't mean it's the truth.

YANBU OP, it sounds like every time you go for an appointment there are students! When I trained as a nurse, I was obviously reliant on people's generosity in consenting to my observing/carrying out procedures (you have to get signed off for certain things as part of your practical assessment document-if you don't do it, you don't pass) but I would be horrified if a patient had felt forced into consent or unable to choose. If it is really the mentor that should be obtaining proper consent.
I allowed a student midwife to deliver my youngest child as I know they have to deliver a certain number of babies during training and mine was an uncomplicated labour and delivery. I offered though, I figured that I didnt mind too much, and it would help her training.

It is a difficult one in that of course students have to learn (and even trained nurses-for example taking bloods and cannulation, you usually have to complete so many under observation to be signed off as competent) but the person should always have the right to say no.

I suppose the problem would come if everybody said no-because the practical element of learning really is important and some things you cannot teach with just theoretical learning.

[quote Mothership4two]@Itsalmostanaccessory

I was induced when having my second child. The person who was about to give me the pessary popped her head in and asked if it would be OK for a student to observe. I said yes. She then came through the curtain and 6 of them walked in behind her. I felt like I couldnt say no after saying yes to one person so has to have my legs open with these 6 students all having a good look and having it all explained to them

My Dad had similar. During his radiotherapy treatment for testicular cancer he went to the hospital one time and was about to be examined first. He was asked if a student could be present and. like you, said yes, only for a roomful to appear - he was mortified but felt he had said yes so couldn't refuse and was too embarrassed to say no then anyway![/quote]
This is awful.

It needs to be understood that permission for a student to observe is permission for one student, not for every student in the department to troup through and have a look.

Some might not mind, but I do think multiple students is invasive in a way that one is not. It becomes about the students not the patient.

@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.

OMG. I am so sorry about your grandpa and the disgusting way in which you were both treated. I am obviously much older than you and have many doctors ASK if I mind a student being present. Most of the time I don't mind, but if I did I would be very clear about it. I'm sorry that I can't offer you comfort at this time. Please be aware that you can always refuse to have students in. In all honesty I would have told them all to leave and made a formal complaint. However as I said I am much older and these days do not take any shit from anyone. 💐 for you and 🥀 in memory of your grandpa

I was a student radiographer a few years back.
From my experience the staff would always ask the patient if it was ok for me to be there.
We always had to introduce ourselves as student radiographers and make sure the patient was ok with that.

I get that students have to learn, but ultimately it is down to the patient whether or not to have a student be present/perform the examination. Especially with more invasive treatments!
I know that I personally would not like a student to watch me have a smear test, however practicing to cannulate on me would be fine.

The NHS is understaffed, underfunded, and struggling. People are struggling to access the services they need and to get the procedures they need.
These students are wanting to come into a service that is strained and they need to learn in order to support it but can't because people feel 'uncomfortable'. It will leave the NHS in a very difficult position.
I'm willing to accommodate the students at all times, anything to help the NHS get more staff, ease the strain and eventually improve services.

I work in the emergency services and have needed to train, people naturally have high expectations, and rightly so but it is a hard area to work in and not everyone is cut out for it. It can be thankless, stressful but many continue to want to do it. Please try and support the new staff coming through.

When i was pregnant with my first all my comunity midwife appointments there was a student there and i never got asked if thats okay. On my 'birth wishes sheet' (went out the window when i gave birth) i put that i dont wish for any student midwifes, its my first, i was unsure of how it would go, didnt want an audiance at my vagina or any extra hands up there and annoyed that im only allowed 1 birth partner but a student midwife is allowed to be there as an extra! When i showed my midwife my birth wishes sheet she made me feel so embaressed questioning (very harshly, she wassant a soft woman) why i didnt want students in the room, in front of the student midwife and made me cry. Then after my birth a student midwife come along to my bedside to remove my cathater (sorry if thats spelt wrong!).

@eclt your use of the world "uncomfortable" in quotes is so disgustingly dismissive of people's complex emotions and anxieties. I would be ashamed!

[quote HacerSonarSusPasos]@eclt your use of the world "uncomfortable" in quotes is so disgustingly dismissive of people's complex emotions and anxieties. I would be ashamed![/quote]
So utterly lacking in compassion and sensitivity for someone who says they work in the emergency services.

How many times does it need to be said that it is not the responsibility of patients in need of medical care to compensate for deficiencies in the training of medical students?

It's not dismissive, people's feelings are very complex indeed and people feel this way for many different reasons. So complex in fact that there is no easy way of describing it in a way that would cover everyone. Whichever way I would have described it, it could have undermind someone or not met someone's circumstances or offended. I could have worded it better, of course, I have the experience in similar areas to have described it better but my post would have been very long, very detailed, and still would have not covered everyone's personal feelings because people's reasons for feeling uncomfortable are very complex, personal and unique to them.

That post was to @ECLT.