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.

As someone with several uncommon genetic organ malformations, I am often used as a teaching resource for medical students. However, I have always been asked beforehand - if I wasn't, I would feel comfortable asking who the extra person in the room was and would be unlikely to give my consent for them to stay had it not been sought in the first place - make it a teaching moment for them on the importance of asking for consent!

Recently, I was in hospital and needed to have a catheter inserted. There was a Nurse and a HCA, who both introduced themselves and explained what was going to be happening, then another young woman entered the bay (I can only assume she was an HCA, as she was in the same scrubs but failed to introduce herself or explain why she was there). I looked at the new arrival pointedly, and eventually asked "Can I help you?", when no one had told me what she was doing there. She looked like a rabbit in headlights, the 2 other HCPs in the room looked up, registering her presence for the first time and looking a bit confused. I suddenly felt really cross, like she had absolutely no right to be there and I wanted her gone, so I announced "This is not a spectator sport, find someone else to stare at." She left without saying a word and the Nurse apologised and said she wasn't sure what she was doing there. It made me wonder what would have happened if I hadn't said anything - would the other HCPs have asked her to leave? Would I have just had to put up with feeling distinctly uncomfortable whilst I had this personal care carried out? I didn't see her again after that, it felt like she could have been a random person off the street who had dressed in scrubs and wandered into the department. This experience really magnified for me how important it is for medical professionals to introduce all of those present to the patient and ensure they have consent to be there.

@LonelySock - you write "My medical school daughter is on a placement at the moment at a GPs. She is enjoying being put with the nurses best of all as they have taught her so much. She of course is too young (grrrrrrr, another issue!) to have ever had a smear test herself and now she's seen several tricky ones and has learnt an enormous amount,"

Do you realise how completely inappropriate it is for your daughter to have told you this? To have been in a privileged position as a medical student to have been given consent by a patient to be present during their smear test - an intimate and incredibly private medical procedure - for your daughter to have then come home and discussed seeing these patient's genitals and describing particular "tricky" appointments to their Mum? I would be horrified if I was one of those patients, she sounds as if she has a lot to learn about being professional.

@BetsyBigNose Actually recanting difficult procedures/consultations following the fact can be completely professional and is encouraged for a multitude of reasons, both with colleagues for peer review/development, or with friends and family as a coping mechanism for example.

The caveat is that the patient individually cannot ever be identifiable from the discussion. For example I've just submitted a case study to university giving a very detailed account of a patient I'd seen and the management provided as part of a masters programme. There was no need to consent the patient and they have no idea their case will be published. However they are not identifiable in the document. Its a requirement of my course for this type of document to be written, if they were identifiable I would fail the module obviously!

Disclaimer - I have not read the thread.

I did placement in a teaching hospital/trust. It was work in theatres... I am not sure anyone gets asked if it is ok for students to participate in your care when you are under anaesthesia. Totally different when you are awake.

As a patient, I always let students participate... how on earth will they learn otherwise?
The only time I said no was in a psych ward on a weekly ward round. Already 6 staff there looking at me, and I could not cope with a student there too.

@BetsyBigNose

@LonelySock - you write "My medical school daughter is on a placement at the moment at a GPs. She is enjoying being put with the nurses best of all as they have taught her so much. She of course is too young (grrrrrrr, another issue!) to have ever had a smear test herself and now she's seen several tricky ones and has learnt an enormous amount

Do you realise how completely inappropriate it is for your daughter to have told you this? To have been in a privileged position as a medical student to have been given consent by a patient to be present during their smear test - an intimate and incredibly private medical procedure - for your daughter to have then come home and discussed seeing these patient's genitals and describing particular "tricky" appointments to their Mum? I would be horrified if I was one of those patients, she sounds as if she has a lot to learn about being professional

It depends how much information was given. As long as patients could not be identified it is reasonable.

Wow you've been really unlucky. There have been students a few times here but they have always checked that it is ok and never for anything intimate.

I'd be ok with one student at a time but not with more than one. I'd feel quite intimidated.