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.

@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?

God I hate this attitude. If someone isn't happy being watched while having a medical procedure it's their choice. Why do some people try to make other people feel guilty for saying no?

My last smear was so painful that I'm in two minds whether to have another one when it's due this year (no lectures please). If anyone thinks I'm going to agree to being gawped at while it's done they can think again!

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 hmm

Ok. Can you explain why 3 trainee health care assistants need to watch vaginal examinations and smear tests? I don’t see that it’s relevant to their role, although I’m happy to be corrected.

Can you explain what medical experience the 4 students actually gained from staring at my face across the room?

Do you think the student dentist is being taught correctly? At some point that student will qualify. You might want a dentist who lies to you, or who doesn’t talk to you or who just starts doing dental work without discussing it with you, but most people don’t.

What do you think will happen to that dentist when she’s qualified and treats patients patients like that?

All this talk about Duty ,don’t you think my dentist has a duty to teach that student correctly? What do you think the consequences will be for that student if I make a formal complaint about her?

The children's hospital in Glasgow is a teaching hospital, and when DS1 was little I was always being asked if students could observe, because apparently he's such classic CF patient. But I was always asked. Not being asked is appalling.

@GreenWhiteViolet

Are there really people who don't understand why some women might not want students observing their gynae appointments?

If I were at such an appointment, I'd be panicky and probably in tears at the thought of getting undressed in front of a stranger. I'd insist that the practitioner was female. I'd be consenting to the examination/procedure, but very distressed by it. Can you see why I might not want extra onlookers, be they students, experienced doctors or anyone else?

I can understand that women with different views and life experiences from me would be totally fine and not mind at all who was there. Is it so hard to imagine that not everyone is like you?

I think, based on some of the replies here, there's some who do understand but just don't give a shit because we need to get over ourselves, stop being precious because it's our duty.

And worrying some of these attitudes are from healthcare workers too.

@MarbleQueen

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 hmm

Ok. Can you explain why 3 trainee health care assistants need to watch vaginal examinations and smear tests? I don’t see that it’s relevant to their role, although I’m happy to be corrected.

Can you explain what medical experience the 4 students actually gained from staring at my face across the room?

Do you think the student dentist is being taught correctly? At some point that student will qualify. You might want a dentist who lies to you, or who doesn’t talk to you or who just starts doing dental work without discussing it with you, but most people don’t.

What do you think will happen to that dentist when she’s qualified and treats patients patients like that?

All this talk about Duty ,don’t you think my dentist has a duty to teach that student correctly? What do you think the consequences will be for that student if I make a formal complaint about her?

Why are you being so dramatic?

Those arent questions for me, those are questions to ask at the time!

I dont understand your behaviour or your attitude, but if its inductive you how you may have broached the subject with the medical staff, I can see why they were less than polite with you too.

*indicative

PinkSparklyPussyCat's comment about how it would stop her going for screening if she HAD to have students present is indicative of how presumed consent and a cultural expectation that its your duty to perform for medical students could damage health outcomes.

Are there really people who don't understand why some women might not want students observing their gynae appointments?

Oh I think they damn well understand. I think the problem is more that they don't care. The attitude is that as long as they are getting the health care they want to a standard they are happy with, to hell with anyone else.

If they cared they'd bother to acknowledge a bunch of the posts on here explaining the reasons why it causes them distress. Rather than ignoring them or using words like 'duty', 'bravery' or the emotional blackmail of how it affects other patients (by this they mean themselves) or their student children.

Women saying "No" are somehow bad. Women shouldn't be able to say "No" because thats bad for society. Women shouldn't be expressing the word "No" because that means we might have to acknowledge and address a problem rather than just ignore it, because its inconvienent and makes us face up to some unpleasant realities about life.

Some of these comments are wild

Of course you should be asked if you're ok having intimate appointments observed

The less intimate ones I think it might be a matter of scale but I wouldn't expect to be asked at a dental appt for example.

And agree that for many patients they wouldn't be able to speak up and say they're uncomfortable, many also wouldn't feel ok saying no when the student(s) are right there

Considering how ott many on here are around dignity for women especially, these comments are very odd.

Those arent questions for me, those are questions to ask at the time!

I assumed you would know why 3 gormless teenagers would need to watch a smear. You seem to know everything else.

Those arent questions for me, those are questions to ask at the time!

Are you illiterate or have you missed all the posts where posters have said they find it extremely intimidating and difficult to challenge things when they are outnumbered and there are people now in the room with them?

Why wasn't the situation about what would happen thoroughly explained? Why is it the patient's responsibility to ask and not the doctor (who is in the legal position of responsibility) not required to do this? Why are you putting it on the patient when the balance of power is with the HCP?

This is a form of victim blaming. This poster said they felt distressed by the situation and you've said its her fault.

As I say and I will reiterate, there are a lot of posters on this thread who simply lack any empathy and don't care about anyone but themselves.

@aristotlesdeathray

Some of these comments are wild

Of course you should be asked if you're ok having intimate appointments observed

The less intimate ones I think it might be a matter of scale but I wouldn't expect to be asked at a dental appt for example.

And agree that for many patients they wouldn't be able to speak up and say they're uncomfortable, many also wouldn't feel ok saying no when the student(s) are right there

Considering how ott many on here are around dignity for women especially, these comments are very odd.

They aren't odd.

They are victim blaming.

We know how widespread that is.

@RedToothBrush it doesn't answer the issues you raised in the post I was replying to, no, so I guess it doesn't help!

[quote Promleafyus]@RedToothBrush it doesn't answer the issues you raised in the post I was replying to, no, so I guess it doesn't help![/quote]
Why is it for PATIENTS to sort DOCTORS responsibilities and to enforce what is ALREADY written into medical ethics in the uk?

What is already supposed to be being done, is quite frankly, regularly run roughshot over, because it serves the interests of the medical establishment.

It does not serve the interests of patients to ignore protocols over consent.

@RedToothBrush are you confusing my post with someone else's? You posted about students in mental health care settings, which is what I responded to and your snappy reply didn't seem to actually be in response to it.

I had a student midwife deliver my baby (until a doctor was needed). I was not asked. The midwife barely even addressed me, and the student looked very nervous. It was during the pandemic and my first child.

I don't mind students learning with me as a patient, but I expect to be the primary focus, not the student's learning!

I agree this is getting out of hand.

[quote Promleafyus]@RedToothBrush are you confusing my post with someone else's? You posted about students in mental health care settings, which is what I responded to and your snappy reply didn't seem to actually be in response to it.[/quote]
Why is it for PATIENTS to sort DOCTORS responsibilities and to enforce what is ALREADY written into medical ethics in the uk?

What is already supposed to be being done, is quite frankly, regularly run roughshot over, because it serves the interests of the medical establishment.

It does not serve the interests of patients to ignore protocols over consent.

HTH

My local hospital is a University Hospital, I'd usually be the 1st in line to say how shit my hospital is but I have to say we're always told when there is a student sitting in on an appointment or doing any procedures. Same at my GP Surgery.

I'm generally happy enough to have them there for most things, but I don't imagine I'd be happy for a male student to be present during any intimate procedures. However, I do now completely refuse students taking blood from me, I'm not an easy patient to take blood from and I've had one too many traumatic experiences of students unsuccessfully trying over and over again! I need an expert!

Okay I mean repeating the same thing over and over doesn't really help. The issue of consent overall is a lot deeper in MH care settings when the majority of patients haven't actually consented to being there anyway, but by the by- interested what alternative for having mental health nursing students around mental health patients you propose whilst they train?

If you read my previous posts you would see I'm in total agreement with OP, but I was intrigued by your post relating to other settings.

I dont understand your behaviour or your attitude, but if its inductive you how you may have broached the subject with the medical staff, I can see why they were less than polite with you too

I’ve glad you’ve acknowledged that medical staff treat you like shit when you have the audacity to decline an audience.

When I've recently had psychiatrist or psychologist appointments recently I've been
asked if students can attend.
I say yes or no depending on how I feel at the time.
For example there was a trainee police officer and I refused because I felt paranoid around the police at the time but recently I said yes to a trainee psychologist because she seemed quite alright.

You know you can always withdraw consent DURING an appointment or procedure too if you are not comfortable with the student.

I know because a long time ago before I got ill I was a student nurse. (Adult general nurse).
Consent is actually a big thing.

I'm shocked by OPs smear experience.
I attended some smear appointments as a student but left the room on the request of certain patients.
I personally would refuse to have one extra person present let alone 3!!
If the practice nurse had a funny attitude to me being shy then let her. I have to take diazepam before my smears and some nurses don't get it. That's up to them.

My GP always has students with them and I am always asked if I mind. What has changed is they are now already in the room instead of being outside and then brought in once you've consented. I've always been OK with it they way they are positioned in the small room means it would be a faff to have to ask them to leave and then move your chair out the way and the whole awkward silence etc so I wonder how many agree to it when they wouldn't ordinarily.

I've had trainee students at almost every gyno appointment I've been to, both male and female. It doesn't bother me in the slightest as I've never seen medical appointments as specifically private, and I like that I can contribute to learning.

But I believe you should always be asked, and your opinion respected. If you are not comfortable then they shouldn't be there, and they should absolutely not perform procedures on you without your consent.

My GP wanted me to have an over 40s check up. I declined as I have a needle phobia and was told DH wouldn't be able to accompany me because of Covid. The GP didn't seem to understand the only way I would actually get there is if he took me but that's another story! However if I did manage to get there I would not be happy about students being there but DH not being allowed to support me.