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.

Some of the responses from people involved in health care, particularly the patronising ones, really show why this is becoming more of an issue.

Definitely a module on manners and respecting/understanding consent missing in some health care professionals.

Shocking!

Ask for a refund.

@JustLyra

Some of the responses from people involved in health care, particularly the patronising ones, really show why this is becoming more of an issue.

Definitely a module on manners and respecting/understanding consent missing in some health care professionals.

Yep. Another obstacle to access if this is how we are viewed, when for some of us it's incredibly hard to even make that initial phone call to the GP.

This thread has reminded me that when I was on the post-natal ward there were. Midwives in their last year who had to tick off tasks and so they were blatantly sharing out my care requirements according to what was needed to finish the course. Now of course this makes sense but I'd prefer not to have a conversation in front of me that goes 'do you want to check the stitches? You still need to do that don't you?'. Again, I'm right here!!

“I suppose it means 'anyone who is not clinically needsd for patient care'.
I don't care if the additional person in the room is s student, a training hcp, a cqc observer.”

Sometimes the trainee doctor is the only person in the room - they are the doctor you are going to see in the clinic, they will then discuss you with the consultant who may or may not then come and review you - is this acceptable? The consultant cannot physically see all the patients referred to them in outpatients. All patients would prefer to see the consultant of course - the referrals are triaged to see who can be managed by a trainee. It is possible to request to see only the consultant but may delay your care.

I wouldn’t want to come across as patronising. I was hoping to enquire what is it the OP wishes to avoid at her appointment and suggest ways to make that happen. Asking for no undergraduates (medical/nursing/midwife students) is a generally easy request and I would expect any clinic to be able to honour it. Asking to not see any trainees is much more complex as is asking to only have the examining hcp present as an assistant or chaperone may be required.

I want to get across the team based model of care that exists nowadays. It may not be obvious what peoples functions are and definitely we should be much better at introducing ourselves, sometimes the “hangers on” do have clinically important roles beyond their own training. There is so much information that needs to be collated and assimilated it’s too much for one person to do own their own.

When a consultant does his/her rounds and comes with an entourage the juniors and students do full-fill a function - they complete the clinical notes, check the drug cards and obs charts, look up scan and blood results and make lists of the actions and investigations needed - it will be the trainees and students who then write the letters, request and perform the investigations and change medications, site cannula etc, it can lead to things being missed if they are not present to take down in real time the record of the discussion and jobs to be done.

There are technical solutions - auto recording of all interactions for example would be fantastic in my opinion so that a “note taker” is not needed and their is no ambiguity in what is said. All of the phone calls where I work are recorded and this saves so much time and stress.

However you do need someone writing a “to do list” and appraising information - now those people might not always need to be privy to the examination but sometimes they might hold a key details from a letter or investigation they have seen that combined with the examination makes a clinical difference- it’s impossible for one clinician to review all the information and ward round 20 patients in an hour. Multi professional collaborative working has been shown to have best outcomes so it is interesting to hear that some patients find it very uncomfortable to have the whole team there and makes me wonder what the solution is.

Sometimes the trainee doctor is the only person in the room - they are the doctor you are going to see in the clinic, they will then discuss you with the consultant who may or may not then come and review you - is this acceptable? The consultant cannot physically see all the patients referred to them in outpatients. All patients would prefer to see the consultant of course - the referrals are triaged to see who can be managed by a trainee. It is possible to request to see only the consultant but may delay your care.

Nobody is suggesting they have an issue with this. You're (willfully) misunderstanding.

The issue is when students, are there purely for their own benefit, to watch, without the patient being asked in advance for their consent, and sometimes even for the pointless observer to fail to introduce themselves or acknowledge in any way their intrusion.

That is entirely different to going to a clinic, seeing a doctor, and the doctor saying they want to get the advice of a consultant because they want to make sure they are giving the right treatment, and then bringing in a more experience person in order to benefit you the patient by giving you better care.

I think I’m trying to say that students and trainees are part of the team and needed in making it all run as it should. Not talking so much about intimate examinations which I agree are a different case but the general principle of students and trainees being involved in all aspects of health care.

A non medical example

I ask a builder to build me an extension. He is likely to come with himself and a brick layer and a plasterer and a roofer and a brickes mate or apprentice - they may also call on specialists such as a plumber or and electrician. The apprentice will be learning how the trades are done and will fetch and carry and pop to get the coffees/more cement etc.

As the customer I would not find it all all odd that the builder had an apprentice nor would I expect the builder to ask my permission to bring him/her along. I would however expect him/her to be supervised appropriately and all the work to be checked by the qualified professionals.

Students are like the apprentice/mate they do the running and the fetching and the simple jobs under supervision and do make things go much more smoothly. I guess I could say I did not want the apprentice along but that would make the builders job harder as he won’t have anyone to pass the bricks/stir the concrete etc. and it might take longer and be done less well.

I would not expect that the apprentice just did some unsupervised building on his or her own and I would expect the builder to fix any errors asap

I guess that this is the same as having a student take your blood or examine you. The qualified hcp should supervise and then fix any errors straight away themselves! Saying you don’t want the student to do it means that you may have to wait longer for the hcp to be finished.

Students and trainees also are the people undertaking much of the quality control and audit of systems - their a free resource - so they are the ones checking the systems to ensure smears are up to date or that the new NICE protocol on this or that is being followed, they are fully intergrated into the system.

A final point is that of funding. Students pay for their training and teaching hospitals receive a considerable amount of money from the universities to provide clinical experience- many consultants are employed by the university rather than the trust - the students fees are paying in a small part for the health care you receive, this does not mean that I think that they should be able to see intimate examinations just because they have paid the money, but it does mean that comments attacking them as “entitled teens” seem unfair - they are contributing to the system now as well as being it’s future

Porky - I was trying to figure out exactly what the OP wanted at her appointment - she asked if her request to the receptionist not to have students would he listened to- I wanted to clarify so I could suggest the best approach for her - patients have requested both from me before and they are different:

1- no undergrad students - tell reception and tell clinic nurse when you see one. Often a slip of paper is attached to paper notes so the hcp picking it up knows before the patient is called in. Shouldn’t effect care much but may cause delays as lack of a general dogsbody so to speak

1. No trainee/postgraduate students - harder but has been accommodated. Can be impossible in an emergency. Can usually be facilitated in GP/outpatients. Will cause delays and may cause problems with your care. Would probably need to make an appointment with GP to discuss and may be best to approach PALS at the hospital and/or write to the consultant directly.

The other point I was trying to make is that their times that a student not simply a “pointless observer” and they may have functions that are not obvious

Women on this thread have described situations where they were clearly being used as a teaching aid and purely observed.

@Cbtb

I think I’m trying to say that students and trainees are part of the team and needed in making it all run as it should. Not talking so much about intimate examinations which I agree are a different case but the general principle of students and trainees being involved in all aspects of health care.

A non medical example

I ask a builder to build me an extension. He is likely to come with himself and a brick layer and a plasterer and a roofer and a brickes mate or apprentice - they may also call on specialists such as a plumber or and electrician. The apprentice will be learning how the trades are done and will fetch and carry and pop to get the coffees/more cement etc.

As the customer I would not find it all all odd that the builder had an apprentice nor would I expect the builder to ask my permission to bring him/her along. I would however expect him/her to be supervised appropriately and all the work to be checked by the qualified professionals.

Students are like the apprentice/mate they do the running and the fetching and the simple jobs under supervision and do make things go much more smoothly. I guess I could say I did not want the apprentice along but that would make the builders job harder as he won’t have anyone to pass the bricks/stir the concrete etc. and it might take longer and be done less well.

I would not expect that the apprentice just did some unsupervised building on his or her own and I would expect the builder to fix any errors asap

I guess that this is the same as having a student take your blood or examine you. The qualified hcp should supervise and then fix any errors straight away themselves! Saying you don’t want the student to do it means that you may have to wait longer for the hcp to be finished.

Students and trainees also are the people undertaking much of the quality control and audit of systems - their a free resource - so they are the ones checking the systems to ensure smears are up to date or that the new NICE protocol on this or that is being followed, they are fully intergrated into the system.

A final point is that of funding. Students pay for their training and teaching hospitals receive a considerable amount of money from the universities to provide clinical experience- many consultants are employed by the university rather than the trust - the students fees are paying in a small part for the health care you receive, this does not mean that I think that they should be able to see intimate examinations just because they have paid the money, but it does mean that comments attacking them as “entitled teens” seem unfair - they are contributing to the system now as well as being it’s future

OK, this is a rather disturbing post.

A final point is that of funding. Students pay for their training and teaching hospitals receive a considerable amount of money from the universities to provide clinical experience- many consultants are employed by the university rather than the trust - the students fees are paying in a small part for the health care you receive, this does not mean that I think that they should be able to see intimate examinations just because they have paid the money, but it does mean that comments attacking them as “entitled teens” seem unfair - they are contributing to the system now as well as being it’s future

"I don't think they should be able to treat your smear as pay-per-view, but..."

That's one of the most staggering, and bizarre, posts on this thread. And that's saying something.

Im a 33 year old healthcare student with lots of understanding on consent and life experience. None of this, including paying for my degree, entitles me to anything. I wouldnt want to observe anything that made a patient uncomfortable or wasnt true consent.

@JustLyra

A final point is that of funding. Students pay for their training and teaching hospitals receive a considerable amount of money from the universities to provide clinical experience- many consultants are employed by the university rather than the trust - the students fees are paying in a small part for the health care you receive, this does not mean that I think that they should be able to see intimate examinations just because they have paid the money, but it does mean that comments attacking them as “entitled teens” seem unfair - they are contributing to the system now as well as being it’s future

"I don't think they should be able to treat your smear as pay-per-view, but..."

That's one of the most staggering, and bizarre, posts on this thread. And that's saying something.

I'm gobsmacked too. I feel quite uncomfortable.

"Your ill body is a resource the universities are paying for access to, for their fee-paying students to learn on".

Yikes.

Multi professional collaborative working has been shown to have best outcomes so it is interesting to hear that some patients find it very uncomfortable to have the whole team there and makes me wonder what the solution is

Hmm. Yeah dead difficult.

Try engaging with patients so they can make an informed choice perhaps?

Years of study and peope still can't grasp the concept of consent involving talking to patients and that they have a right to make informed choices about their care - including the right to refuse to have a bunch of people parade in on them if that makes them feel uncomfortable.

Its almost as if they have a complete disregard for the concept of making decisions for themselves and doctors think they should be infantilised and have decisions made on their behalf.

Yep this is 2022.

@draramallama

I worry about what these students are learning about consent in these circumstances.

I agree with you. Unfortunately these completely reflects the NHS's toxic culture around consent - or rather the culture of failing to seek consent and assaulting patients instead.

This, absolutely this. It is common with a lot of people dealing with birth trauma to have been heavily affected by lack of consent, some have felt as if raped/sexually assaulted during birth.

This God complex seems to be getting worse with the cult of NHS worship, there’s no room to criticise anything, there’s a culture of covering up mistakes and a feeling we should be unconditionally grateful for this service we pay for through taxes. This is what is leading to lack of consent being the norm (although they seem very keen to get you to sign bits of paper when you certainly haven’t got the capacity).

@Cbtb

I think I’m trying to say that students and trainees are part of the team and needed in making it all run as it should. Not talking so much about intimate examinations which I agree are a different case but the general principle of students and trainees being involved in all aspects of health care.

A non medical example

I ask a builder to build me an extension. He is likely to come with himself and a brick layer and a plasterer and a roofer and a brickes mate or apprentice - they may also call on specialists such as a plumber or and electrician. The apprentice will be learning how the trades are done and will fetch and carry and pop to get the coffees/more cement etc.

As the customer I would not find it all all odd that the builder had an apprentice nor would I expect the builder to ask my permission to bring him/her along. I would however expect him/her to be supervised appropriately and all the work to be checked by the qualified professionals.

Students are like the apprentice/mate they do the running and the fetching and the simple jobs under supervision and do make things go much more smoothly. I guess I could say I did not want the apprentice along but that would make the builders job harder as he won’t have anyone to pass the bricks/stir the concrete etc. and it might take longer and be done less well.

I would not expect that the apprentice just did some unsupervised building on his or her own and I would expect the builder to fix any errors asap

I guess that this is the same as having a student take your blood or examine you. The qualified hcp should supervise and then fix any errors straight away themselves! Saying you don’t want the student to do it means that you may have to wait longer for the hcp to be finished.

Students and trainees also are the people undertaking much of the quality control and audit of systems - their a free resource - so they are the ones checking the systems to ensure smears are up to date or that the new NICE protocol on this or that is being followed, they are fully intergrated into the system.

A final point is that of funding. Students pay for their training and teaching hospitals receive a considerable amount of money from the universities to provide clinical experience- many consultants are employed by the university rather than the trust - the students fees are paying in a small part for the health care you receive, this does not mean that I think that they should be able to see intimate examinations just because they have paid the money, but it does mean that comments attacking them as “entitled teens” seem unfair - they are contributing to the system now as well as being it’s future

Wtf? Unbelievable. Things really haven’t moved on from ransoming bodies of those who died in workhouses/with unpaid medical fees and students paying to dissect their bodies have they?

This entitlement of the medical profession wrecks peoples lives. You’re seen as a commodity in order to earn money.

@JustLyra

A final point is that of funding. Students pay for their training and teaching hospitals receive a considerable amount of money from the universities to provide clinical experience- many consultants are employed by the university rather than the trust - the students fees are paying in a small part for the health care you receive, this does not mean that I think that they should be able to see intimate examinations just because they have paid the money, but it does mean that comments attacking them as “entitled teens” seem unfair - they are contributing to the system now as well as being it’s future

"I don't think they should be able to treat your smear as pay-per-view, but..."

That's one of the most staggering, and bizarre, posts on this thread. And that's saying something.

Given patients can't chose whether they go to a teaching hospital or another hospital, the very idea that students are the most important ones in the hospital suggests patients should always be offered an alternative hospital if having students there is compulsory at teaching hospitals.

Indeed given the nhs is supposed to be equal care for all regardless of income, its a bizarre concept that students should be able to buy slots at the expense of patient consent.

Anyone would think that patients don't pay for their healthcare through their taxes.

Patients aren't there for the convenience of students or doctors....

Interesting to see the different experiences.

I'm incredibly lucky that whenever there's been a student present I've always been asked if they can stay, if they can watch/have a look.

Doesn't really bother me they've got to learn somehow. But absolutely it should be patient choice and clearly explained.

*I ask a builder to build me an extension. He is likely to come with himself and a brick layer and a plasterer and a roofer and a brickes mate or apprentice - they may also call on specialists such as a plumber or and electrician. The apprentice will be learning how the trades are done and will fetch and carry and pop to get the coffees/more cement etc.

As the customer I would not find it all all odd that the builder had an apprentice nor would I expect the builder to ask my permission to bring him/her along. I would however expect him/her to be supervised appropriately and all the work to be checked by the qualified professionals.*

You’re comparing my house to my body. My house doesn’t give consent for me to live there, it’s an inanimate object. My house hasn’t experienced trauma which makes medical examination tricky, my house has never had a flashback or panic attack. My house couldn’t care less what happens to it because it’s not a sentient being.

My body however, is mine. I get to decide who looks, who touches and who listens. I get to decide if X is too much for me at any given time. Utterly bizarre comparison. Yes clinicians need to learn, part of that learning needs to be that people for many varied reasons may not want or may not tolerate too many people in the examination room with them.

We teach children about the importance of consent from a young age, the “my body belongs to me” doesn’t change because it happens to be in a medical facility at the time. And it’s not the same as a bricky working on my garden wall.

You’re comparing my house to my body. My house doesn’t give consent for me to live there, it’s an inanimate object. My house hasn’t experienced trauma which makes medical examination tricky, my house has never had a flashback or panic attack. My house couldn’t care less what happens to it because it’s not a sentient being.

Quite.

Its funny how people who lack empathy continue to show they lack any concept over what medical consent is and why it is necessary.

Patients aren't there for the convenience of students or doctors....

They're often treated as an inconvenience to be honest. I remember being in hospital years ago and no one introduced themselves, I had no idea who the people were and what they were doing and I was patronised when I had a reaction to one of the drugs (I was imagining it because I was upset apparently). This is the point my intense but manageable dislike of needles became a full blown phobia.

On the subject of staff introducing themselves, does anyone remember Dr Kate Granger and her 'Hello My Name Is' campaign. When my Mum was in hospital a few years ago the doctors were great with her and I remember some of them wearing the name badges. Mum was blind so it would have been easy to talk over her and only one bitch of a doctor did that, everyone else treated her with respect, even when she was unconscious.

I was a student nurse from 1997-2000 (didn't pass, long story) and I always remember working in an outpatient department when a gay couple came in. The doctor asked the couple if I could stay and listen, and they said no. So I immediately left the room. I think that's entirely reasonable.

I will always let students observe unless it's REALLY personal.

Having said that, I agree with the OP. Of course students have to learn but I think we are returning to the "bad old days" of consent being implied, not sought. The patient or service user is not a performing monkey for you to prod and critique at will, nor is the patient/service user being difficult by refusing. Some consultants just presume...and that's not right.

people think medical students aren’t in training to be doctors what are they? I’m surprised that people think that doctors don’t need to know how to deliver a baby or perform a gynaecological exam! Medical students are sometimes referred to as “student doctors” so it’s clear they are the same level as “student nurses” or “student midwives”, that is desperate to “trainee doctor” which refers to qualified doctors who are not yet consultants or GPs.

I disagree.

Some of these students will be heart or eye doctors or children doctors. They won’t ever deliver a baby or have to examine someone’s vagina.

It’s a difficult one, students have to learn, but sometimes you just aren’t in the right frame of mind for it. I had a lovely MS Nurse, one day three students attended for my appt. I was having a really difficult time generally and just cried through most of the appt, I felt embarrassed, but I just couldn’t pull myself together.