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.

I'v been that student so I understand it's important however they really should ask as soon as you turn up for the appointment.
By saying 'x will be observing today' they're framing it so the patient is more likely to say yes and feel awkward asking them to leave.
I'v allowed students to scan me at fetal medicine, a student at my birth as the room was already filled with paediatricians etc. However anything I was feeling anxious about where I was feeling exposed I wouldn't allow it. The attitude that women should just allow people to observe gynae procedures regardless of their feelings so students can learn is baffling.
I did have a junior dr ask me to remove my bra when totally unnecessary once which has also put me off consenting to students/junior drs.

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.

I don't do anything with patients bodies in my current job. It's not a male student asking if he can observe a smear test.

@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.

Patients in healthcare settings are often vulnerable and the HCP is in a position of power. Nobody is suggesting that they don't need to learn. It's the assumption that it's OK that people are querying.

I'm in NHS podiatry and every single patient is asked their consent for both the students presence in the room and consent for any treatment. I thought that was standard!!!!

@draramallama Well said, it’s v concerning, the coercion and entitlement from some medical staff.

I feel like I’m in some sort of other universe.Several people keep asking how are they expected to learn. Gaining consent takes seconds and doesn’t prevent them from learning.

They can learn after they have gained informed consent. They shouldn’t be anywhere near patients until they grasp the very basic concept of informed consent.

No wonder so many women have horrific births when health professionals don’t grasp this concept.

I’m surprised people think it’s ok the dentist thought it was ok to lie and practice on me without my consent.

And I'll also add the following year my female consultant said there was a male student hoping to observe and asked if I was ok and said if I don't feel comfortable at any point and unable to ask him to leave after what happened with her colleague the year before I can cough and will have him leave, that was totally fine and he was pleasant and out me at ease straight away and I allowed him to examine me.

Had k walked in and he was already there I really don't think I'd have felt able to say because I'd have been having flashbacks to the hands in my vagina while drugged or and angry consultant being angry I cried when he hurt me.

It makes a massive difference being asked first without having to say no in front of the student.

You left without having a smear?
What did they say when you said you were uncomfortable? What do you mean insinuated you were being silly?

@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.

Nobody is saying they must learn from a textbook though? They are saying that patients just need to be asked and give their permission.

I would be fine with students and pleased to help them learn. However if I wasn’t asked permission then I’d feel reluctant and unsure.

And if someone isn’t happy or comfortable then that’s their right to say no thanks.

[quote AutomaticMoon]@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.[/quote]
But you know about it, so it proves my point that it was widely publicised. I believe it was actually published / talked about for years before any changes were made.

I think there's mostly some sort of student there's but I've always been informed and if I remember correctly asked for consent.

I usually don't mind. The only time I refused was when I was in labour and the student was going to be male. I felt super guilty. Still do especially since I had quite a few male consultants look at me later during the same delivery when things didn't progress as they should have. Your thread has made me feel better about that so thanks.

@Itloggedmeoutagain

You left without having a smear? What did they say when you said you were uncomfortable? What do you mean insinuated you were being silly?

Whats wrong with leaving? If I go for a procedure and decide not to go ahead at any point, for any reason, I can withdraw consent and leave. I've heard it before from HCPs "It's nothing we've not seen before" being a particular favourite. I don't care how many fannies they have seen, mine is not normally opened up and peered into by strangers.

@SC215 Ambushing people before they come in doesn’t sound good for the patients. If they have PTSD/cPTSD they can easily say yes as they feel trapped and expected to say yes. HCP should really have trauma informed training.

I think it jas changed OP. When I had dd a medical student came, politely introduced himself and asked if he could observe the borth as part of his training.

When ds was born 7 years later he was delivered without my knowledge by a student midwife. To be fair it wasn't a good time to ask me much since I was screaming that I needed a poo!! In the end it was a good thing and I am sure he's now a superb midwife - one of the calmest most reassuring people I've ever met. DS was his qualifying baby .. (40th delivery). It was such a lovely feeling when he told me that. 😀

I do think as a rule though patients should be asked rather than consent assumed. I wonder how many anesthetised patients are operated on by students without their knowledge or consent.

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?

What a load of bollocks and excuses. It takes seconds to ask someone.

@NoRaceInThisHorse 😁 ‘But I’ve seen gajillions of fannies, is yours made of diamonds?’ - a probable quote from a HCP

I once had a scan for a DVT. I was sitting in the consulting room and a technician came into the room and said he was a student and he would be doing the scan. I refused and he got really shirty with me. I told him that if has asked for my consent first, I may have considered his request. There was something about his casual arrogance that really pissed me off. He left without saying a word and another member of staff came in a did the scan. I’m not a piece of meat to be used for practice.

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

Haha... They aren't ALL the cream of the crop intellectually... But I'll agree that many are.

Nobody is saying they shouldn't get this experience. All that OP is saying is that they should get the patient's consent first. Most of the students I've known and work with expect that not all patients will give consent on that day. It's fine.

You don’t know if they were medical students or junior doctors though. People have to learn and patients who refuse are in my view akin to the unvaccinated allowing others to bear the burden of risk while they enjoy the benefits

I agree. How are they expected to learn properly if everyone can't possibly have them in the room? I bet those who object would be the first to complain if someone had qualified without ever having seen the procedure done, or helped with it, and they were the "first" they had ever done it on!

@listsandbudgets I’m sure you’re aware of the issue of anaesthetised women undergoing pelvic exams from students without consent or being informed?

I do agree the patient should be asked for consent, but don't think it should be refused unless there is an extremely good reason.

@GinIronic Good on you! I feel sorry for the women he encountered who had trauma or anxiety who didn’t feel confident enough to decline 😞

SC215 obviously I don't know what branch of medicine you practise but if you treat mental health issues I would say the same applies.

Anyhow, not going to get into a ding dong with you, and thankfully I have now got past my childhood experiences to a point where I can confidently say no. Some people can't and won't ever get to that place. I hope you can consider them.

I’m intrigued about the dental students as I thought they only practiced in designated training centres attached to hospitals and clinics which make it very clear students will do the work. I’ve never come across one at an individual practice.

I’ve always been asked for permission with students. I’m no ot particularly bothered about the wording and would feel fine saying no if I really needed to. I do think it’s a valid point that if the person is qualified it’s a totally different situation as they are part of the team treating you and different to a student.

The NHS has been like this for ages. A friend trained as a doctor 15 yrs ago and the stories he told re consent were very depressing. Basically they are taught they no one is ever going to voluntarily allow students to practice how to do medical procedures on their body so they do it without consent. Oh