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.

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*

The entitled teens in the family planning clinic were not trainee doctors. They were trainee health care assistants and there was no reason for them to be there.

It’s a Completely different scenario to a nurse who needs to learn to do them as part of her role.

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!

Do they need to learn to do prostate exams or vasectomys or circumsicions?

I’m not being sarcastic.

Further to an earlier post of mine regarding withdrawal of consent during procedures to which @RedToothBrush said it was 'easier said than done', I actually have experienced doing this successfully.

I stopped the nurses doing 3 of my smear tests part way through as I felt so uncomfortable, & also when I had an endoscopy I was supposed to have it without sedation. But I was so uncomfortable I pulled the scope out of my mouth & throat myself so the doctor gave me sedation as I wanted.

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

I want to avoid students who don’t need to be there and who aren’t relevant, like I explained previously about the difference between 3 health care assistants trainees gawking at you having a smear and a nurse who needs to learn to do them in her role.

If I had a leg appointment for example I’d have no objection to a trainee leg doctor being there. I don’t want trainee health care assistants or kids on a work experience placement.

@MarbleQueen

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!

Do they need to learn to do prostate exams or vasectomys or circumsicions?

I’m not being sarcastic.

Cam somebody within the medical field please answer this?

Just from a male perspective. I have PTSD. I needed a rectal (sorry!) exam done, there was a male consultant and female student. The consultant was geared up to do it until I said no. He bent over backwards to accommodate me and the student did the exam. Male privilege is definitely a thing sadly. So sorry for your horrific experiences.

@PearPickingPorky @JustLyra It IS a disturbing post - there’s no such word as ‘intergrated’ afaik 😭

@Latara

Further to an earlier post of mine regarding withdrawal of consent during procedures to which *@RedToothBrush* said it was 'easier said than done', I actually have experienced doing this successfully.

I stopped the nurses doing 3 of my smear tests part way through as I felt so uncomfortable, & also when I had an endoscopy I was supposed to have it without sedation. But I was so uncomfortable I pulled the scope out of my mouth & throat myself so the doctor gave me sedation as I wanted.

Bully for you.

Lots of people couldn't manage to challenge.

Just cos you managed it, doesn't mean everyone feels able to.

They are only gonna be 19-21at this point. They’re gonna be qualified doctors by 22-23 and could be an independent GP partner by 27 so I’m not sure how it’s possible to object to them being late teens early twenties at the start of training is logical - they are going to only be a year of so out of school because in only a handful of years out of school they are going to be doctors!

This post has bothered me a bit and I think I’m going to struggle to explain why.

Yes some of them will go on to become qualified doctors. Some won’t. They are not doctors yet. Some of them are 18 year olds who’ve recently started university and have limited medical experience.

Yet the Nhs and the students themselves seem to expect the public to treat them like doctors today.

Are there any other professions where students expect to be treated as fully qualified years before they are?

Yes! I remember being asked previously if a student was present, if I was ok with it. Recently had a colposcopy and was told the young male student doctor would be present, not asked. My examination then lasted longer as she explained to him what she was looking at on the screen. Not great, I don't usually mind students but would've preferred not havocs one for that procedure.

@Knackeredmommy That’s completely disgusting, I would be been suicidal if this was done to me. Luckily I don’t try to get help from NHS anymore so not much chance of it happening. But this is one of the reasons I have tokophobia and can’t have a baby, it’s not really fair.

@AutomaticMoon, it wasn't great, it's an uncomfortable enough awkward procedure as it is, he didn't say a word to me and I was just waiting for it to be over with as they discussed cells etc.. I don't know why I didn't speak up..

The house comparison doesn’t work emotionally as other posters have pointed out.

I note you present the student builder as a cheerful skivvy getting mundane things done so builder can crack on. But student builder would actually have to learn so building your house would take twice as long because builder is cantering the student instead of you.That means your bathroom might be refitted 6 times just so student gets to learn.

Student doesn’t need to fit bathrooms anyway. He’s going to specialise in roofs so will never fit another, it was just something he had to tick off.

Now add in that the 18 year old student expects to be treated the same as the qualified experienced builder. Plus he stares intently at you and never acknowledges you.

In Spain where I live you don't get asked and it would be considered very odd to complain about medical students being present and outside serious trauma (rape victim not wanting students present at any intimate examination for example) I think that the default should be students present, no need to ask permission but that there is an "opt out" box.

@Knackeredmommy that's really bad. I'd have probably said he needed to leave but I know it's really difficult to do and I just really can't hack them being there. I actually phoned the hospital before my last colposcopy to ask them to ensure I only saw female HCP's. Told them I'd wait longer to see a woman if necessary.

Recently had an appointment for my son. We were informed on our way to the room that someone else would be sitting in. We were not asked if that was okay. We were not told why he was there. Neither of us were bothered as it was a quick physio appointment. But they didn't ask for consent. The other person in the room didn't take his head away from his laptop. I dont understand his reason for even being there.

Every other appointment in the past, I have always been asked if it was okay that another person was sitting in, along with the reason why they were there.

I wonder why they are no longer asking for consent with this kind of thing. Especially for more personal and private appointments.

@MarbleQueen

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!

Do they need to learn to do prostate exams or vasectomys or circumsicions?

I’m not being sarcastic.

Yes they do.

I've examined more prostates during medical school than I have delivered babies.

Every time with express informed consent from the person involved.

@Knackeredmommy Aw please don’t feel guilty for not speaking up, I’m not surprised you didn’t, many of us just freeze when in a situation like this. I was never taught boundaries or how to stand up for myself and I think many are the same, how can we be assertive when the opposite is modelled for and expected from us?

@Changednamesorry You mentioned ‘serious’ trauma, what is non serious trauma? What if they were just held hostage for a year but not raped, would that not count as ‘serious’ trauma?

@Changednamesorry You should know that cPTSD acquired from long term childhood abuse causes the symptom of not being able to trust adults in positions of authority and it’s not just ‘intimate’ procedures that are triggering, it’s any situation where your boundaries are trampled over and adults in positions of authority feel entitled to use of your body.

@Sodthebloodypicnic - you could always have examined each other's prostates. If it's fine for patients it should be fine for you all. The same with vaginal exams.

I've examined more prostates during medical school than I have delivered babies.*

Every time with express informed consent from the person involved.*

Nice that the men always get to give expressed informed consent when they are having intimate examinations isn't it.

Shame the same can't be said for women- one quick look one the childbirth section on here will show how often consent seems to go out of the window when a woman is in labour. And that's just one example- unnecessary examinations under GA where no consent has been given is another. Sure there's plenty more.

It’s common sense that a student midwife will need to learn to do vaginal examination. But it doesn’t make sense to me that a student doctor who’s going to be a cardiologist has to do them.It’s not even relevant to their training and never will be.

I suspect something similar happens with other types of students. Maybe this explains the difference in the attitude between these students. It seems some are there to actively learn and participate in certain areas and they do so professionally and people don’t seem to mind.

I wonder if the silent staring ones with a bad attitude are simply ticking things off. Possibly they don’t want to be there and have no interest in that particular area of medicine. I wonder if the 3 students who were brought in midway through my procedure were ticking something off.

@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?

@GreenWhiteViolet

Me too. I find all medical appointments really hard, but any sort of gynae/intimate procedures are absolutely horrific for me. I cry in the days leading to the appt, when driving there and am a quivering and sobbing mess by the time I get to the consulting room. If I arrived to find a bunch of onlookers, I'd walk straight back out.

A student midwife was with me throughout my sons birth, and she was lovely but I physically couldn't cope with what many women are describing on here. I'm not a piece of meat or a medical dummy to be touched and observed on someone elses say so.

would be unusual for the placement in obs and Gynae to be first year stuff as they tend to cover the basics like chest and abdomen first but in their second or third year the student will get their obs and Gynae block as this is their only training in that before they qualify

I think this is a real problem.

Many women here have described troops of students appearing in childbirth or gynaecology procedures. I think many people would assume that these students are training to be obstetric or gynaecology doctors and agree to be examined or observed believing it’s an important part of their training.

I hope I’m wrong, but it sounds like all student doctors do a stint in these departments just to tick boxes. Is this correct?