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.

@Blossomtoes why wouldn't that happen? I did it, as did all my peers.

I have a disability and had lots of hospital appointments related to it as a child. I remember being asked for my consent for students to be present from when I was about 8 years old. I presume my parent was asked as well, but I remember the doctors explaining it to me, and that I agreed to it. This was decades ago. It's really shocking if some people aren't even being asked now.

I haven't seen an NHS doctor in a long time, but if I did, I'd be happy for students to be present for routine things, but not anything related to my mental health or anything which would involve them seeing intimate parts of my body. Those things are too private and personal. If other people wouldn't mind, that's fine for them, but we should all have the option to decide for ourselves.

I was a student paramedic up until recently and although I introduced myself as a student and I’d always ask for consent before performing any sort of procedure, it’s a lot more difficult to get ‘true’ consent in the way you’re suggesting @MarbleQueen because I was already in the house when it’s being asked. I don’t know what you’d want us to do in that case because the alternative is waiting for another ambulance who probably also have a student?

[quote arghdilema]@Blossomtoes why wouldn't that happen? I did it, as did all my peers. [/quote]
It wouldn’t happen at my surgery.

@Wineandrun, I don’t get your comment at all. No of course it doesn’t help that it was an enriching experience for the student midwife… If something is traumatic, who would be able to separate out their own response to that extent and be glad they’ve supported someone else’s learning, albeit been left traumatised??? It’s irrelevant how the student midwife feels in these circs tbh.

I had this with a gynae. I wasn't told there was a student in there. I'd specifically asked for female doctor when booking. Walk in and there's a young chap sitting next to her. I've been sexually assaulted by drs and raped (not by drs). It's actually in my notes. I came in and went into a kind of shock. She didn't introduce him. I started visibly shaking, could barely speak when she asked why I was there. I eventually managed to stammer out that it said in my notes I needed to see a woman only. She sniffed and said she'd not read my notes. I apologised to him - and by then he was standing up to go, apologising to me and saying it really wasn't a problem. And he left. She carried on being a bitch and I wish I'd reported her (I was advised to by another medic later but I couldn't face it).

I apologised to him again as I past the reception desk leaving and he again said it was totally fine.

To the people saying "They need to learn". Of course. But there are many ways for that. If you are happy for your body to be used and viewed like that (including multiple people staring at your genitals) go for it. But your comfort with it does not transfer to everybody. Volunteer yourself to the medical school where they can get a chance to try out on you.

It's also possible to practice things on realistic dummies now and if that's not possible, then they always have each other. And if that's not ethical, then why on Earth is it ethical to practice on people who are by definition of being unwell and seeking help, vulnerable, without consent?! Or with coerced consent (which isn't actually consent).

OP I believe you. There are people who think that once someone enters medical school they develop wings and upon graduation a polished halo appears, I'm guessing they haven't spent much time in bars that medical students frequent, listening to them one-up on the grossest vulva or biggest testicles of the day, or smelliest body etc*. In life or death situations, consent may need to be bypassed. On all other occasions there's no excuse for anything other than informed consent.

*I have dr friends who don't do this. However, I spent a fair amount of time in uni in the vicinity of nee students in bars, beer gardens etc and there were too many who did - and the ones who didn't, didn't shut them up.

Of course consent should be obtained, I have had this on a few occasions and always been happy for them to sit in on appointment. I was a student once and the experience I gained during my placements/ actually doing the job taught me so much more than the lectures!

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.

Just re read this. Do you mean a vaginal exam here OP? An unnecessary, unchaperoned one? That is shocking and should definitely be raised as a concern/complaint.

@Dinosauratemydaffodils

Then in your case i'd phone up before appointments to make sure it's noted. But realistically (and my mum has SMI so i do get it) you are a rare category. The majority of people would be fine being asked on the day of a first apppintment to something.

Things like labour are tricky and I'm sorry- you went through such an awful thing. That should not have happened.

And i believe everyone having surgical medical procedures, labour ect should have an advocate to ensure informed consent during vulnerable times. I know i was so drugged up and in agony after foot surgery i couldn't give informed consent. Not nice.

For bog standard appointments, therapy ect. You can also bring along someone if that helps.

But again, just sticking to standard appointments like OP has. Splitting hairs is useless. The outcome re consent should always be your wishes and always asked - again never seen it not be.

I have had a student or resident etc. in the room for procedures, including colonoscopy. Last time my gi specialist brought me in the room and there was someone else there. They didn't seem like they were going to tell me who he was so I asked. Then they told me, asked me for consent etc. i was fine with it but I like to know.

I had gyne surgery last year and have recently received a letter from the hospital saying I had a phony, fake nurse during my surgery. I am now wondering if I need to check credentials too.

I have still been asked.

If you really don’t like it then I would contact the surgery and have it put on your notes. The hospital might be a bit more difficult but if you are there quite often I would have thought a note could be attached. You have every right to refuse.

I have little experience of how it works in primary care/outpatients where you are going into a room and I can understand why it makes you feel a bit ambushed. They should absolutely ask for consent.

But in a hospital setting (again only from a nurse perspective) whilst our students are supernumerary unnofficially they are absolutely counted within the numbers and expected to be delivering care. Infact most were on nhs contracts all 2020 and employed. They are trained in moving and handling and basic life support and a large amount come from a support worker or care background. We ask consent prior to every care delivery "hello Mrs Smith, its the student nurse here would I be able to check your blood pressure" and as explained before they are all working under a registered nurse so I would check absolutely everything. Within some wards at the moment overnight there can be ratios of 1 nurse to 16 patients which is less than 4 minutes per hour per patient, so students nurses are considered part of the team and actively involved in the day to day work because some shifts I literally wouldn't make it through without them.

Another thing that happens constantly in hospital during intimate examinations is that the doctor will request a chaperone especially when a male doctor. I believe that if this is what has happened with yourself some strong communication around why this is required would go a long way rather than you feeling like a piece of meat. The chaperone would often be a student nurse because they are the most available on the ward.

I was about to undergo an operation a few years back. A student doctor came in and asked if he could observe. I said no. Felt bad for him but I just don’t want anyone observing. You should never feel pressurised into being observed. No need to give a reason.

Yes I have noticed this also. "Allowing" (I wasn't asked) a student to perform a procedure turned out very badly for me recently, and I had to have a major surgery as a result.

LoveFall That is awful. Wow 😲 can you do anything to follow up how that happened. I would want an explanation after they investigate.

it’s a lot more difficult to get ‘true’ consent in the way you’re suggesting @MarbleQueen because I was already in the house when it’s being asked. I don’t know what you’d want us to do in that case because the alternative is waiting for another ambulance who probably also have a student?

Are you saying you were a student paramedic and you were out on calls with no trained supervisor?

If student medics can't observe they will have less chance to become good at their jobs.... which is what we want!!

@Lessofallthisunpleasantness

If student medics can't observe they will have less chance to become good at their jobs.... which is what we want!!

And if people don't feel they can say no, there is less chance some will seek care. Which is what we do not want.

had gyne surgery last year and have recently received a letter from the hospital saying I had a phony, fake nurse during my surgery. I am now wondering if I need to check credentials too

I don’t understand. Do you mean someone pretending to be a nurse?

@Lessofallthisunpleasantness

If student medics can't observe they will have less chance to become good at their jobs.... which is what we want!!

Oh RTFT will you?

No one is saying students can’t learn. They are saying they can learn after informed consent has been obtained from the patient.

@MarbleQueen
No of course not, I was with a paramedic and either a technician or another ambulance student paramedic ( I was a uni student paramedic so was a ‘3rd man’ on the crew), but my point was that there was no way of asking patients to consent to me being there without me already being there.

@NoRaceInThisHorse

Then it's simple. If they have such trauma that they can't say the word 'no'. They phone up before an first appointment and explain and have it added to file for x service.

@Blossomtoes

but that is not the same as an A level student doing work experience at the local GP practice to fill out their application to medical/nursing school

That wouldn’t happen.

If you'd read the BMJ link, you'd see it does happen and A level students are advised how to go about it.

Like I said, it wouldn’t happen at my surgery 🤷‍♀️

I want to be really clear that having students at gp and hospital appointments is not a new thing in my area. We are part of a teaching hospital and it’s been this way for as long as I can remember. It’s not been a problem.

You would turn up for your appointment and the receptionist or gp would say they have a student on a placement and do you mind if they sit in. You would say yes or no based on your own preference and the appointment would go ahead.

The problem is not the students, the problem is they have stopped asking for consent.

To the person wondering if the healthcare assistant was brought in as a chaperone from a ward. No. This happened at a family planning clinic and no one would need 3 chaperones.