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

I don’t think that’s how consent works, surely?!?!?

How should patients be asked for consent about students? Genuine question.

@SC215

How should patients be asked for consent about students? Genuine question.

We should be asked "is it okay if a student/s sits in on this session?"

It's very easy.

And the poster who got a group of students with her dying relative - that explanation should have taken place out of earshot of patient and relatives.

Thinking about it I've been wheeled into theatre twice already out cold so lord knows who was present there

I don’t mind students being present at all but I agree with most posters here that it would nice to be asked before any type of procedure or examination was done on me and for it to be monitored. It sounds like you’ve been unlucky with the amount of students you’ve had but you have every right to say no if you don’t want a student at your appointment.

I have a history of borderline ovarian cysts & have had several operations and have routine internal ultrasound checkups to monitor for recurrence. Eventually after I’ve “completed” my family I’ve been told I’ll need a hysterectomy. So each time is a bit un-nerving never knowing what they’ll find or want to do. I once had a student at my ultrasound appointment and the consultant said to the student that he was going to let her prep/start off the internal ultrasound for him (I assume for experience..and to be honest I thought ok everyone has to learn and said it was fine). He left the room for a moment and she began the ultrasound and then started telling me that she could see both ovaries and reassured me that everything was fine. My consultant came back in and took one look at the screen, told her that she had put the wand in upside down (camera facing wrong way) & was looking in completely the wrong area - all said in front of me. I felt a mixture of sorry for her and also a bit sorry for me. Luckily nothing was there when I got correctly scanned, but I’m not sure how i would have felt if she had given me incorrect information.

Gaining consent takes seconds and doesn’t prevent them from learning.

YES!

BUT

precious you clearly doesn't want to see any student before appointment

This isn't realistic for 99% of people/services at a first appointment. It would frankly take more time to boot student out then potentially call them back then ask question then get on with appointment.

Here's how it works

You arrive (hopefully on time for appointment)

You walk in, see 2 people instead of 1.

You are asked if you will allow student to observe (however way they phrase the question you are still being asked)

You say no

Student walks out.

Sorted in less than 2 mins :)

Then, if your having frequent appointments with X service you can ask for it to be specifically noted. Most services aren't joined up so you'd have to do them for all obvs.

Oh wow lovely! You do realise phoning people could easily take 10 mins with them hanging on the phone, or the redials or the interruptions if they phone back having missed your call

When the simple question could be asked far more quickly in person on the day

@SC215

How should patients be asked for consent about students? Genuine question.

On booking in at the appointment: "We have a medical student working in the GP surgery/clinic etc today. Would you rather see the doctor alone or are you happy for the student to sit in?" (framed as a choice, not a blanket "are you OK with that, which forces a "yes").

Simple.

I genuinely do not have a problem with students…they do need to learn !

We should be asked "is it okay if a student/s sits in on this session?"

It's very easy.

But not by the student themselves, or 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?

The nurse acted like I was weird for feeling uncomfortable, they were trainees and had to learn. All girls together, nothing they hadn’t seen before and no reason to be shy or embarrassed.

It was nothing to do with being embarrassed. I don’t give a shit about them being embarrassed.I don’t want 4 people present for an intimate procedure. It’s not necessary and like many other women I find them extremely traumatic due to abuse.

Something else, and I have never seen it before.. Usually there is a standard bed against the wall with a curtain round it.

On this occasion there was a strange chair in the middle of the room with stirrup type things on and no curtain round it. The bottom of the chair was facing the door. I’ve never been back there and felt quite sick that I was ambushed like that.

@HonestwithHope1

Gaining consent takes seconds and doesn’t prevent them from learning.

YES!

BUT

precious you clearly doesn't want to see any student before appointment

This isn't realistic for 99% of people/services at a first appointment. It would frankly take more time to boot student out then potentially call them back then ask question then get on with appointment.

Here's how it works

You arrive (hopefully on time for appointment)

You walk in, see 2 people instead of 1.

You are asked if you will allow student to observe (however way they phrase the question you are still being asked)

You say no

Student walks out.

Sorted in less than 2 mins :)

Then, if your having frequent appointments with X service you can ask for it to be specifically noted. Most services aren't joined up so you'd have to do them for all obvs.

Oh wow lovely! You do realise phoning people could easily take 10 mins with them hanging on the phone, or the redials or the interruptions if they phone back having missed your call

When the simple question could be asked far more quickly in person on the day

This !

Sorry that should be -

This isn't realistic for 99% of people/services at a first appointment. It would frankly take more time to boot student out then ask the question then potentially call them then get on with appointment.

Again,,i think your splitting hairs, the outcome is the outcome for your wishes of consent regardless if student is in the room when question is asked

I am sorry this has been happening to you. I am a medical student, albeit a fairly ancient one.

Where I am placed, it has been drummed into us from the start to:
a) introduce ourselves and our role, and ask for informed consent for each specific individual thing (eg observing, doing a specific procedure, etc)
b) raise concerns immediately if patient safety/dignity is being compromised, as it would have been in some of the situations you described above.

From what I have seen myself, everyone including the younger students have done this including in theatres when patients are asleep (ie gaining consent from the patient before scrubbing in.)

I am also a healthcare assistant and from what I have seen, the nursing students are very professional too. They are more hands-on/thrown into the deep end though so I am not sure what the protocols are for them, and whether midwifery students are similar. It may be they are more integral members of the workforce.

As far as medical students go, there are also various stages to avoid things being missed/patients feeling put on the spot. At the GP, for eg, the doctor would ask the receptionist to ask the patient on the phone first whether they consent to a student being present; then the GP would ask the patient in the waiting room; and then the student in the consultation room would introduce themselves and triple check.

I am aware that in a hospital setting it’s sometime hard to be so thorough but the last point, if not the latter two, should apply.

I would also like to stress that students should never act put out or take it personally if they ask if it is alright to observe/do a procedure/take a history and the patient declines, regardless of whether the student is already in the room. Of course this isn’t to discount the fact a patient may find it tricky or impossible to do so.

If you have the energy, I wonder if you could face contacting PALS and the relevant universities. Patient consent and dignity should be paramount, and the universities/ward managers etc should be very interested and worried to hear your testimony; or if they are trying to brush this under the carpet, then it would be all to the good to have it spelt out in black and white so it is harder to minimise.

@Spicez why is an 18 year old less likely. Those who want to go into medicine are expected to have done work expensive/shadowing before the application is made. If op lives needs a large teaching hospital it's perfectly plausible to have a student at each appointment.

@SquirrelG not wanting to have an extra person looking at your vagina is a perfectly valid reason for a women not to consent to a student being present during a smear.

@NoRaceInThisHorse

We have signs up everywhere saying that it is a teaching hospital, students may be present, and to let the receptionist know if you would prefer not to have them in the room. I still thought it was important for students to introduce and ask the patient themselves, but maybe I will stop that now!

@HonestwithHope1

Sorry that should be -

This isn't realistic for 99% of people/services at a first appointment. It would frankly take more time to boot student out then ask the question then potentially call them then get on with appointment.

Again,,i think your splitting hairs, the outcome is the outcome for your wishes of consent regardless if student is in the room when question is asked

Be very simple for the receptionist to do the asking and flag on the system if the patient says no, surely? If the next person has a flag, the student steps out. Simple. No time wasted.

@SC215. Please don't stop this! It's a vital skill and you are clearly doing it in the right way!

I’ve always been asked, all the way through my pregnancy etc.
Not bothered - that’s how they learn.
I’d be unhappy with males tho, if I’m honest

The only time I remember not being, was when I was early 20s ( so too afraid to challenge) and seen a male GP and was literally knee to knee with a young male student.
I think I had a UTI. Even then I wasn’t too shy or embarrassed about most things- but I do remember not being “asked” and just “told” he was observing ….

Just to add that from what I’ve seen I would say in hospital it’s the norm for the student to already be there, but it’s also the norm for them to seek informed consent and, crucially, the norm for some patients to decline this. It’s par for the course and not an issue.

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

I worry about what these students are learning about anything at all if patients kick up a fuss about them being present.

@SquirrelG

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.

And that's why I would find it hard to say no when asked when the student is there, if I had to give a good enough reason to be allowed to say I'd have to explain things I can't even talk to my dh about, to strangers. I probably wouldn't bother with smears or any kind of intimate health problem if a simple no thank you I'm not comfortable with that was enough.

What if my reason given isn't good enough? Who decides what's a good enough reason? What if the person asking me for the consent is a "not all men" type? and tries to change my mind or dismiss me anyway?

Here's how it works

You arrive (hopefully on time for appointment)

You walk in, see 2 people instead of 1.

You are asked if you will allow student to observe (however way they phrase the question you are still being asked)

Bollocks again.
The receptionist can ask at booking in. And you’re missing the point, they are not asking anyway.

I think you're heavily exaggerating! That's a huge list of appointments all with all these students milling about? I've had four children,hundreds of appointments in my life of all kinds and only ever had one student present and I live in London. If you don't want some one there say so and complain if you have to but remember everyone starts somewhere and this is how they learn,I've often thought it's strange I don't see it more often at any of mine. Apart from your birth story which does sound awful I think you're being a bit of a drama queen, sorry

That student midwife will remember you and your baby forever. I’m sorry you felt so ambushed and uncomfortable but if it helps at all, you have played such an incredible part in her training, career and vocation.