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.

@ECLT

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.

Anything for the sainted NHS, eh @ECLT?

So utterly lacking in compassion and sensitivity for someone who says they work in the emergency services.

If it's the emergency service I'm thinking of it doesn't surprise me.

@LumosSolem

So utterly lacking in compassion and sensitivity for someone who says they work in the emergency services.

If it's the emergency service I'm thinking of it doesn't surprise me.

What, the AA?

Them too @Warmduscher 😂

There are two different types of consent. For any procedure you will be asked to sign a consent form. If you are in a teaching hospital then the form contains wording to the effect of 'this is a teaching hospital and as such nursing and medical students may be I attendance. Please raise with your supervising consultant If you have queries' the consent forms can be long and this can be missed by the patient. However if the medical or nursing or any student is to take part in the procedure this MUST be discussed with you and you must give explicit consent for this.

@Kteeb1

There are two different types of consent. For any procedure you will be asked to sign a consent form. If you are in a teaching hospital then the form contains wording to the effect of 'this is a teaching hospital and as such nursing and medical students may be I attendance. Please raise with your supervising consultant If you have queries' the consent forms can be long and this can be missed by the patient. However if the medical or nursing or any student is to take part in the procedure this MUST be discussed with you and you must give explicit consent for this.

Surely that wording should say “if you have any objections”, not “if you have any queries”?

I always like to have students present in any medical setting because it usually means the instructor will go into more detail and use more technical terms, which I find interesting. I also find the students have more interesting perspectives. I wouldn't necessarily expect to be told that a student was present, but it's usually obvious.

I'd also never refuse to allow a student to perform a procedure on me as long as the instructor was present (unless the student had been very rude or something).

Ds had brain surgery when he was 3. What he had was very very rare in a child so young... His surgeon asked me about students visiting him for their case studies I said it was fine...we had a steady stream into his room ..all bought kids magazines small toys or smarties , his surgeon had told them not to come into his room empty handed :) boy was very happy at all his loot and all the nice doctors who wanted to chat with him.

I've noticed it myself, previously they'd always introduce themselves and ask if I was comfortable with their attendance, now they are just there in the room, or actually getting involved with no question of if I'm happy for them to be there or not. I'm personally not bothered by it, once had 20 of them in an operating theatre with me, they need to learn somehow and if it improves the level of care they provide and medical knowledge they have, I don't see the problem.

@CoalCraft

I always like to have students present in any medical setting because it usually means the instructor will go into more detail and use more technical terms, which I find interesting. I also find the students have more interesting perspectives. I wouldn't necessarily expect to be told that a student was present, but it's usually obvious.

I'd also never refuse to allow a student to perform a procedure on me as long as the instructor was present (unless the student had been very rude or something).

That’s great, as long as you don’t expect patients who don’t want students observing or performing procedures on them to do the same.

Some posters on here seem to think the primary purpose of a medical consultation is not to give care and treatment to a patient, but to provide training experience for students, and that anyone who objects - for whatever reason - should be prepared to explain how they expect students to learn if they don’t agree to it.

@Warmduscher I said 'words to the effect of'. It was not a direct quote.

[quote Kteeb1]@Warmduscher I said 'words to the effect of'. It was not a direct quote.[/quote]
Even“words to the effect of” in the example you gave allows no room for objection, only query.

@WotsitMum

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!).

This is unacceptable. I'm sorry you were treated in this way.

@Whatsyourfavouritescarymovie

I've noticed it myself, previously they'd always introduce themselves and ask if I was comfortable with their attendance, now they are just there in the room, or actually getting involved with no question of if I'm happy for them to be there or not. I'm personally not bothered by it, once had 20 of them in an operating theatre with me, they need to learn somehow and if it improves the level of care they provide and medical knowledge they have, I don't see the problem.

You don't see the problem, when you've said yourself that there is 'no question of whether you are happy with them being there or not?'

I actually see this as another barrier to healthcare for a lot of people, especially women, who face enough barriers as it is. As if it's not difficult enough, trying to even get a GP appointment, no GP service at weekends when you work full time in the week and struggle with appointments, particularly as a single parent, having to tell a receptionist the nature of your problem (I do understand the need for triage but in some circumstances it can make than initial phone call even more difficult when you are struggling), a lack of female HCP's in certain areas. These are already barriers to healthcare that exist so having to walk in to an appointment and face a medical student who is already there waiting, and have to be the one to ask them to leave, rather than being asked for consent before a student even enters the room (prior to appointment would actually be best!) just makes things even more stressful for some people and potentially creates another barrier.

I figure these students will be treating me when I'm old, so I'm happy to let them learn with me as their patient.

I don't really understand why you're being so precious about it. They have to learn somewhere, it's not like they're doing it for shots and giggles

That said though, you should be asked and give consent. I've had a trainee midwife, plenty of GPs, trainee doctors in hospital, trainee dentist. Not a trainee nurse yet though

@Nidan2Sandan

I figure these students will be treating me when I'm old, so I'm happy to let them learn with me as their patient.

I don't really understand why you're being so precious about it. They have to learn somewhere, it's not like they're doing it for shots and giggles

That said though, you should be asked and give consent. I've had a trainee midwife, plenty of GPs, trainee doctors in hospital, trainee dentist. Not a trainee nurse yet though

Yeah because it's for 'shits and giggles' that the OP objects to having more medical staff in an appointment than is actually necessary for her to receive the treatment she needs.

Or could it be that there are potentially complex reasons as to why she might feel uncomfortable, because you know, we are all actually different and not everyone feels like you?

We seem to be caught in a cultural race to the bottom where the mentality is we should be grateful for what we are given by the precious NHS and are unable to constructively criticise and say that poor standards in bedside manner leave to poorer clinical outcomes and poorer mental health.

For a country which makes a big song and dance about having the best health care system in the world this is utterly fucked up.

You don't improve and make advances in health care by saying 'oh just put up and shut up'. And its coming from people who are All Right Jack types who don't have mental health concerns. They are effectively happy to throw those who really struggle with this type of thing (often for a perfectly valid reason that stems from a past life experience which has left them vulnerable or traumatised in some way) under the bus. As long as they are getting the health care thats sufficient for them to hell with everyone else.

Lets spell this out. People who are secure and don't have anxiety health problems are happy to ignore those health problems because mental health is unimportant and we should only be concerned about physical health. Mental health is an indulgence and something that people should just snap out of.

How do we progress and move the NHS forward with public and clinical attitudes like that? Is that really the model of health care we want? Is that really universal health care for all in the vein of NHS ideology thats held up as the gold standard?

We know that poor mental health costs this country billions which are passed onto other government budget lines or other NHS departments. The cost effectiveness of acting like a gigantic god complex dickhead when you are a doctor, does not stack up. People will seek medical attention earlier if they aren't afraid and have a good relationship and trust with the health care system. That means that overall they cost the NHS less.

Numerous studies and reports have found the same. They have been focused on particular aspects of care but the findings all state similar.

The bullshit of just suck it up or we will have no doctors is a logical fallacy based on fear not fact. It is accelerating problems with costs to the NHS which will only exacerbate the issues we have. Its certainly not going to fix the problem. Its likely to make it far worse.

And it leaves a whole bunch of vulnerable people or those with (often diagnosed) anxiety issues up shit creek in the mean time - at a cost to their health.

A slow hand clap is the only deserving response to all the people on this thread going on about 'duty' and 'bravery'. It sounds like attitudes towards shoulders who were hospitalised with shell shock a century ago who were thought of as weak and not doing service to the country in the way they should have. Bollocks to that.

People should make formal complaints because it is the only thing that leads to official recognition of the problem. Force the NHS to address it. That will lead to improvement. Better experiences with staff might even inspire patients to join the NHS themselves as nurses and doctors...

It’s amazing that after a thread full of examples as to why people may not want to be observed during appointments people are still playing the “baffled why you wouldn’t” line.

I don't really understand why you're being so precious about it.

In my case, it's because my trauma is not a teaching moment. If I attend appointments for antenatal reasons or my daughter's hv check up, I don't think it's acceptable to sit and listen to a hcp discuss the reasons for my ptsd diagnosis with a student. They framed it as important experience for the students, seeing how trauma can affect maternity care/mothering but it made me feel absolutely rubbish and wishing to disengage.

Attending appointments is hard without more obstacles being placed in the way. Oddly enough my diagnosis is all over my notes because when I present with such random things as a burn (caused whilst sleep deprived reaching over a boiling kettle) or a broken bone I get asked if it's self harm linked but yet they never seem to make the leap that hearing someone else's take on my trauma or extra bodies in a room where I'm exposed and vulnerable could be problematic.

Do people have any opinions on how students learning to work with people who have mental health problems (eg MH nurses) should be trained? Many PPs have suggested that people with MH problems shouldn’t have students in at all/shouldn’t be asked due to trauma or pressure, but for a student MH nurse this patient group makes up their entire placement experience. I know that someone’s trauma shouldn’t be a “teachable moment” but if no one’s trauma is ever used for teaching then students just don’t learn about trauma. The same goes for people who lack capacity. Many inpatients on a MH ward will lack capacity, so in theory can’t consent to students but, in practice, MH wards make up a large proportion of MH nursing placements and those wards only really function because the students are acting as HCAs. What’s the solution?

@Dinosauratemydaffodils

I don't really understand why you're being so precious about it.

In my case, it's because my trauma is not a teaching moment. If I attend appointments for antenatal reasons or my daughter's hv check up, I don't think it's acceptable to sit and listen to a hcp discuss the reasons for my ptsd diagnosis with a student. They framed it as important experience for the students, seeing how trauma can affect maternity care/mothering but it made me feel absolutely rubbish and wishing to disengage.

Attending appointments is hard without more obstacles being placed in the way. Oddly enough my diagnosis is all over my notes because when I present with such random things as a burn (caused whilst sleep deprived reaching over a boiling kettle) or a broken bone I get asked if it's self harm linked but yet they never seem to make the leap that hearing someone else's take on my trauma or extra bodies in a room where I'm exposed and vulnerable could be problematic.

My mental health is precious and my dignity is precious. And I think there are many of us who feel the same.

Its sad that people think in 2022, that being concerned about your mental health or dignity is 'being precious' rather than considering why certain practices could be improved to ensure that people don't need 'to be precious'.

There really are some cracking oneliners littering this thread from posters who are willfully and deliberately missing the point and can't be arsed to take the time to read and consider the experiences of others and why this has caused actual distress to them. Instead they are happy to call people who are suffering from trauma or anxiety as 'being precious'.

Cos obviously treating trauma and anxiety are not health issues.

The utter ignorance and total lack of empathy that leaps off the screen is staggering sight to behold isn't it?

[quote RegardingMary]@AutomaticMoon

Don't get me started on sweeps!!

I've had 4 children, I know what a sweep feels like. I was examined in my last labour and despite verbalising it moments before the examination and despite it being written in my birth plan, the midwife did a sweep. I know this because when I asked to her why have you done a sweep? I've not consented to that.

She told me
'Well I was there anyway so just thought I might as well.'[/quote]
This is absolutely disgusting and is assault. How dare she? I am so sorry that happened to you.

You want to try giving birth to twins there were about 500 people in the room
The thing is they have to learn, but you are right you ought to at least be asked.

@Nidan2Sandan

I figure these students will be treating me when I'm old, so I'm happy to let them learn with me as their patient.

I don't really understand why you're being so precious about it. They have to learn somewhere, it's not like they're doing it for shots and giggles

That said though, you should be asked and give consent. I've had a trainee midwife, plenty of GPs, trainee doctors in hospital, trainee dentist. Not a trainee nurse yet though

Well yes and lots of people genuinely don't mind which is great, but absolutely those that do for a plethora of reasons of which they don't need to justify should be able to say no thanks without being pressured or even worse for it to happen without being asked.

@JennieTheZebra

Do people have any opinions on how students learning to work with people who have mental health problems (eg MH nurses) should be trained? Many PPs have suggested that people with MH problems shouldn’t have students in at all/shouldn’t be asked due to trauma or pressure, but for a student MH nurse this patient group makes up their entire placement experience. I know that someone’s trauma shouldn’t be a “teachable moment” but if no one’s trauma is ever used for teaching then students just don’t learn about trauma. The same goes for people who lack capacity. Many inpatients on a MH ward will lack capacity, so in theory can’t consent to students but, in practice, MH wards make up a large proportion of MH nursing placements and those wards only really function because the students are acting as HCAs. What’s the solution?

Realistically putting a trainee on a mental health ward before they are fully trained elsewhere isn't really appropriate. Its a speciality and should be treated as such. Its an area that people should gradually build up to, not have a troop of students with clip boards. A hell of a lot of mental health stuff is about bedside manner, which you can learn in other departments well enough. By the time you get to the stage where you might be asked to restrain a patient, I'd hope you'd already be a junior on a ward, with a certain amount of other experience under your belt and be working with more senior doctors rather than being 'a student' so to speak. If this isn't the case, its really fucked up and needs addressing anyway.

Not only that, it depends on the nature of the problem and what stage of distress someone is at. A proper assessment of the patient prior to making them a subject of students is appropriate. An 'on the spot' request, shouldn't really happening. Plus, some people will be fine with a request - cos y'know, not all mental health patients are the same.

Where you have a patient who has trust issues and a stated on record expression of not liking HCPs then its probably not a good idea to be approaching them... and it should be part of training to think about who is appropriate to observe and who is not...