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.

In my hospital, there are signs up saying that it is a teaching hospital and if you would rather not have a student present during your care, please let staff know. So it is a sort of opt out option.

Personally I make all medical or nursing students introduce themselves to a patient and ask their permission to observe or carry out any care. As in "Hi, my name is Adam, I'm a final year medical student, I'm here to observe for the day, is that okay?". I've noticed that the majority of the medical students are very uncomfortable introducing themselves to patients, which is a bit worrying.

Saying that, we've all got to learn somewhere. When I was a nursing student, no patient was happy for me to catheterise them under full supervision from someone, so it meant that I qualified without having done it on a real person. Luckily it turned out I was quite good at it!

Just say no

If there has ever been a student in the room when I have entered which happened a lot during maternity related appointments, the healthcare professional has always introduced them and why they are there, asked if I was OK with them being there and also where appropriate asked if they could observe or participate in doing checks, procedures. I felt comfortable that I could have declined and reassured that it was OK to do so as they addressed this upon me entering the room. As it happens I'm fine with students being involved as long as the experienced person is watching their progress as everyone has to learn somewhere but I know many people who would be upset by this which is why I think my trust are clearly and sensitively addressing this at the point you go in.

@MarbleQueen Medical gaslighting and coercion is real. The nurse was trying to coerce you, how incredibly unethical. I have to wonder about why people feel like ‘my body, my choice’ is unreasonable? Consent is still necessary even in medical situations, or is informed consent being sought a thing of the past? Like the Hippocratic oaths?

In our trust we always ask and always accept when someone says no to students. They don’t need a reason to refuse.

I’m sorry you have had these experiences.

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?

@shouldistop I am disabled and don’t have a lot of energy, in 2020 I was busy working night shifts in a care home, my
Mother was dying from cancer, and I was living in uninhabitable housing. I didn’t have time to read the news everyday in case the NHS decided they’re entitled to my organs. The NHS have been exposed for organ theft already, so I guess they wanted to legalise it.

Hi, my name is Adam, I'm a final year medical student, I'm here to observe for the day, is that okay?"

Your student is TELLING patients he’s going to be observing them. The “is that ok” isn’t really a question in those circumstances, and especially not in a group.

Why can’t you get consent from your patients in private then invite Adam in once they’ve agreed?

Six different appointments….that’s a lot of times in two years!

I've had students observe several tests and procedures in hospitals over the past 15 years, they have been pointed out to me and my consent checked. I like hearing the extra explanations. On my DC1s 20 week scan 15 years ago I was given a thorough scan though all her organ systems and lots of photos for free. I thought they had to check consent.

Is there a PALS group you can complain to?

Work in clinical setting with students.
I always ask patients if they are ok with student - sometimes they say no. That's fine.

I do not see the problem at all with this. How can we have sufficiently trained medical professionals if patients refuse to even let them observe a senior doctor or specialist? Hands on practice and patient interaction under absolute supervision is the best way to learn these things. I’m not saying they should be allowed to play shop during brain surgery but come on, let them observe a smear.

OMG OP 6 appointments in 2 years, how coukd you?! 🙄 I bet OP didn’t go 6 times for fun, probably it’s something to do with their unwillingness or ineptitude to diagnose or actually help her?

We arent all monsters who have no idea of consent unless we are taught it you know I did my placement last year and asked every patient with capacity if it was OK, one said no so I left. Those without capacity I informed who I was and respected any non verbal communication I received.
Ive always been asked if I want students present. Its ok to say no or to say youd like them to leave.
I see other posters asking how you expect them to learn. There are plenty who consent, so they will learn. Your right to choice shouldnt be bent by obligation to help others learn.

People don’t see the difference between saying no thanks don’t bring them in and having to say to a students face erm can you fuck off please?

Some people have been raped and have PTSD, I can’t believe the cavalier entitled attitude showed by some here to women’s bodies/vaginas.

I don't mind them, they have to learn somehow, what's the big deal? The man in the GP appointment might be different if it's a sensitive issue.

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

What a daft thing to say. I’d prefer to be asked, you know, just basic courtesy that most of these students don’t possess.

Look, trainee anything’s don’t get to roam around the hospital barging into rooms with the belief they’re entitled to observe anyone’s body or practice on anyone without their consent.

Most places I have been have a sign (usually fairly small) explaining the students may be present and to ask if you don't want them in there.

It's shockingly bad practice to just have them in the room! I once had a nurse at a hospital ask if it was OK for a medical student to take my blood, which was fine with me, but if they hadn't asked, I would have been annoyed!

@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?

I don't think she's against the concept, just that the patient should consent.

And no, I wouldn't want extra people around while I had a smear because due to trauma I find them difficult and get a lot of anxiety. On the other hand if was, say, a chest infection or knee problems I wouldn't mind a student being present.

@StellaGibson118 Exactly, well said! Plenty have no problem with it but some do, so consent must always be sought. I’m glad to see you have a humane attitude to it :) maybe not ALL medical staff are monsters 😜 just wish you weren’t the minority!

@Katya213

Six different appointments….that’s a lot of times in two years!

Did you miss where OP specified she had had a serious condition? I'm fairly sure she doesn't rock up for personal and intimate examinations just for something to do on a Tuesday afternoon.

There's a huge difference between medical students and junior doctors.
Junior doctors are qualified doctors, they've passed medical school, they can look after you independently in an emergency (while getting more senior help). They do not consent to be there. They are working and learning on the job and an integral part of care. Even if that's sitting in outpatients listening to a more senior person.

A student whether medical (training to be a doctor), nursing, midwifery or any other health profession is pre qualification and not qualified. They need training but aren't part of the system in the way junior doctors are. There presence needs consent (though lots of places are doing an opt out consent with posters up telling patients to say at the desk if they don't want students).

Junior doctors are all doctors who are qualified but not a consultant. They range from finished medical school 2 days ago, to 20 years ago and come out of training for life reasons. Junior doctors (at registrar level) are often the most senior doctor on site especially out of hours. You don't get a choice about having them there.

I hate the fact that the students/trainee doctors are always sat there when they ask if you're okay with them observing. I have ptsd and find appointments hard enough without extra people. The worst example for me though was a home visit with a hv and student hv...the hv explained to the student in front of me all about my ptsd diagnosis and the trauma behind it.