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.

YANBU as a student myself , I would always ask for consent and make sure my patient is comfortable but we need to learn . If every patient says no we can't get competencies signed off . We can't then go onto be a competent practitioner if we haven't done these skills. I always let students be present in my own care.

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

Speaking for myself, no, but I would much prefer actually being asked (before the student comes into the room) if I mind an extra person down the business end.

@LondonQueen Some people have trauma from abuse in childhood, of course it’s a big deal to someone who had adults do whatever they want to your body, and now seemingly adults again feel entitled to your body?!

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

Not really.

4 of those things were a birth, a smear test and a dentist and gp appointment so pretty standard.

The other 2 are related to an ongoing health condition.

I don’t see the issue here. Students need to learn. I’d be quite taken aback if I was asked to consent to a trainee healthcare provider being in the room or involved in my treatment. It’s not as if they are some random person with no reason to be there.

. I think ive always been asked if not in advance at least on the day. I wouldnt object in any instance and would treat them like drs....althoigh they looked well out of their depth when i eas in labour and then i treat them like kids! I have 3 nect wk at my smear test, i dont love it but feel sone kind of oblivation to allow it

It’s normal how else do students learn? I’m what’s called a zebra in medical terms and pretty much every time I go to the doctors or hospital there’s a student there. It doesn’t bother me as they are there in a purely medical basis not for fun and games. I had a gynae procedure recently and had students in the room it’s fine .

@Dinosauratemydaffodils What the actual fuck??? That’s completely unacceptable 😞

@CharlotteRose90

It’s normal how else do students learn? I’m what’s called a zebra in medical terms and pretty much every time I go to the doctors or hospital there’s a student there. It doesn’t bother me as they are there in a purely medical basis not for fun and games. I had a gynae procedure recently and had students in the room it’s fine .

I think you meant to say it's fine for you OP clearly is not comfortable, so that should be that.

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?

I send the student out to the waiting area to introduce themselves to the patient on their own, and to ask if it's okay if they observe. I don't go with them to ask, as I think it's important for students to get used to talking to patients themselves, and if they are already in the consulting room then the patient might feel more pressured to say sure that's fine.

I dont mind. I never forget having an internal in late teens when ask if it was ok for student to observe. Said yes and they brought in TEN!! (I had unusual gynea issue). Luckily mum was holding my hand. After that nothing phased me. I ended up comforting the male medical student who was observing my iud being fitted. He was way more embarrassed than me lol

Eons ago...
When I was 42 (!!) weeks pregnant with dd1 the consultant turned his back & announced that I was breech & they would do a trial labour & if that didn't work I would need a caesarean
It was his student who was next to me who spoke to me sympathetically & explained
That I always remember - when I finally started labour (I had to be induced - they wouldn't do that these days form what I have read) & got to the final stage they asked me whether it was OK to have student because they rarely saw breech delivery I was so far gone I couldn't care less
I wished I had had a caesarean

How do you think medical students learn? These are the cream of the crop intellectually and are the future of our health service. It’s disconcerting that so many of you think they can learn complex treatments from a textbook.

For intimate/gynae type stuff I don’t think it’s acceptable to just have students there and expect the woman to specifically request they leave. Women should be asked beforehand whether they’re happy with students BEFORE said students are there, in order to gain true consent.

Plenty of women will be happy to have them present, and probably even more comfortable at the fact their autonomy and consent has been respected from the start. It also ensures women who aren’t comfortable with students for any reason are able to easily decline.

I can’t really see why anybody would argue against that.

Back in the bad old days before consent became a vital part in the proceedings, students would allegedly perform intimate examinations like VE / PR on patients who were under GA for other ops. Horrible

Okay so yeah.

You are being incredibly pedantic especially when you are going into their place of work

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

....

Time - students will be possibly preparing to meet you, interact or even treat. That doesn't go out the window on the off chance someone may (rightly obviously) say no. Prep can involve both the space + educator also, you may not show which is often and it literally takes 2 mins for a simply bloidy yes or no question to be asked.

Time with educator/senior staff. It's important and if they are waiting 10-15 minutes for mrs no consent but maybe mrs no show. They aren't booting student out until you arrive at room and get asked that all important question.

Space- buildings aint that big. I set up/dismantled our therapy room after previous patients/groups- our offices were tiny-crowded at X time so i just hung out in therapy room reviewing my schedule- obviously clearing out if not my group/patient/no consent .. but shock horror, most patients, gasp! Saw me and knew i was a student.

If i was waiting for a potential observation consent yes I'd be waiting in the room i'd been working in, helping educator set up ect

Back to that time thing. If you have ongoing same person appointments like in CMHT then yeah, it's noted and the system will show it. We'd call ahead for home visits but again. Do you think every health professional has the time to phone (and potential miss you involving pita redials ect) and discuss something that when you come in, can be said in 2 mins?

@grannybiker

Back in the bad old days before consent became a vital part in the proceedings, students would allegedly perform intimate examinations like VE / PR on patients who were under GA for other ops. Horrible

This is still legal in some states in America, I’ve seen student drs on online forums defending the practice Medicine does have a terrible history of misogyny and lack of respect for autonomy unfortunately

@BrainPotter

How do you think medical students learn? These are the cream of the crop intellectually and are the future of our health service. It’s disconcerting that so many of you think they can learn complex treatments from a textbook.

Literally no one has said that

What is being said by many of us is that permission should be asked and matters should be dealt with sensitively.

Which can happen...but you know, OP, I suspect this is part of a wider problem that privacy concerns are ignored in many ways, and the NHS medics have a weird status know where we fear questioning in case we are labelled problem patients. I sympathise.

For me, I'm an unusual organic being anyway, and I guess yea, if you want to study me, then yea, hope I can be a useful study.

Sorry SC215 but that is really bad practice. Women with PTSD or other trauma from sexual assault often "freeze" and become compliant when faced with someone assuming it's okay to do something to their bodies. Which your "Adam" pretty much is.

OP I have had this too, repeatedly, a male student sitting in on an appt where I needed to mention having been raped, a student MW looking on interestedly whilst I had a procedure that was distressing to me, a student HV and another time GP turning up at the door for postnatal stuff, and the best was a consultant telling me she had "shared my story" of trauma due to CSA with a group of medical students hanging awkwardly about a few feet away and could one of them interview for a patient of the week (or similar) presentation she had to give?

The posters explain their will be students present, and that you can ask them to leave, which you do. I wouldn’t overthink it they need to learn yabu, if you don’t want them there just say.

I’d be worried if everyone asked them to leave though, how they would ever be trained and work on their skills? They gain knowledge from observing consultations. As when they qualified you would expect them to be competent so I’m not sure how they achieve that. I think if you paid privately for treatment there wouldn’t be students as the students are all NHS taught and funded.
You’ve also been unlucky to have had so many! I’ve only had one student midwife and the lady doing my scan was a final sign off student, she did it alone with her mentor coming in at the end and she told her the findings, gave us a load of extra free scan pics for been patient with her, never a student nurse or doctor.

Also back to consent. Every student including myself previously also spoke up during conversation and said how we are happy to leave, it's no problem ect. I've even had a few people happily change their minds, one memorable lady sniffed and said 'you look more competent than I thought' ... Bit strange compliment haha

I've also been happily booted out. No complaints or awkwardness. Again. 2 min convo. Not the end of the world

I've had some fucking brilliant students look after me and make a big difference to my acre when the qualified people were very dismissive.

But, 20 years ago I've also had three male student be told to insert their hands into my vagina while I was in no capacity to consent and heavily sedated and then made to feel like a piece of shit when I was upset by it. I was told i was not sexual to get over myself. I would have said no and asked them to leave had I not been so drugged up and unable to speak or move and that one experience still makes me super anxious for all medical appointments even now.

Another time, a male consultant examining my breast tissue a few weeks after surgery to remove a lump squeezed so hard I cried and had a bruise on my tit for a few days after, I cried with the pain and I got called "delicate". The nurse in the room at the time stood up to him and told him he was being way way too rough on someone who who only had surgery a few ago and he stormed out. My usual consultant was off that day for whatever reason and something must have been said because she rang me the next day and apologised and urged me to complain. I should have, but after the experience of trying when the I had hands on my vagina ten years before.

I have two student nurses in my family who have said some of the surgeons and consultants think they can do whatever the fuck they want and have been threatened with their careers when questioning why they haven't asked the patient for consent. Sweeps are another area, many women don't get asked and it just gets done to them and I've seen threads on here say the woman should be grateful and she shouldn't expect asking before a hand is out inside her. It's really not ok.

Our GP practice is a training practice and always has trainees in almost all appointments. We’re always asked if it’s ok. I’ve always given consent. How else are they supposed to learn?

I had a student midwife on her very first day as a student for dc2’s elcs. She was absolutely delighted, and I was happy she got to experience it. She came and sat with us for an hour at the end of her shift too, and said thank you and talked about how much her first ‘birth’ had meant to her.

All that sounds awful, OP. In my recent experience, I have been asked every time if I am OK with a student being present (& there nearly always is one there). I have consented provided they didn't perform the procedures (gynae related).