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 know this is a sensitive subject to many people.
My DS1 is alive today mostly because a midwifery tutor as they were known 52 years ago, brought two student midwives into room while I was in labour. She asked me if I would be happy for the students to palpate my abdomen as part of their training process.As a former student midwife myself I agreed despite being in really bad pain.
The tutor pulled down the sheet covering me, then without touching me immediately stood back, told me it was best or a doctor to see me first and quickly left the room taking the students with her. She returned within minutes with a doctor who proceeded to feel my my abdomen nodded his head then quickly left leaving the lovely tutor to tell me that my baby was in danger and I would have to have a crash caesarian now.
My waters were meconium stained as well.The nurses came and got me on a trolley and ran with me on it to the theatre. My son was actually in transverse lie and a Bandle's ring had formed around him.He was brought out of me with an Apgar of 1 which is almost dead but was successfully resuscitated.
Even today I wonder what would have happened if I had not been used for a teaching subject at that time.The section had other complications as well but it was life saving.

EmbarrassingHadrosauru Im aware of this practice and this is part of my issue. It’s interesting that many posters seem to think that all students are trainee doctors or third year students.

I suspect the young man at my gp appointment was on a work experience thing, he looked about 17.

No one should have people they don’t want present for their healthcare. It can be really overwhelming and traumatic.

I do wonder is people say no more now and this has led to a change in policy:

However male medical students often qualify as Doctors without ever having seen a birth or performed a vaginal exam and then go onto be then junior doctor on overnight for obs and Gynae performing their first ever exam unsupervised on a real sick women and that’s not great either

(Source - married to a Dr who qualified without ever seeing a birth or doing a vaginal exam despite turning up every day for his 4 month obs and Gynae placement)

I’m a qualified dr (trainee GP) and just started a new job so wanted to watch the people who work there already for a few days to see how the computer system worked etc. Patients were asked before and most said no. So instead I just got dropped in the deep end consulting on my own - not a smooth experience for my first few patients!

Not sure what the solution is.

find it laughable that someone is raging about a first/or one off service appointment getting agro about consent being asked not in the exact way she'd like

Can you not read? I’m not being asked at all.

It wouldn't bother me but I have been part of a medical research study for about 25 years, so am more than happy for students to sit in.

I would draw the line if it was a yr11 on their work experience week

With 1st dc I was asked if I minded students being present during antenatal, birth, postal, naively said yes. Didn't realise that during my complicated delivery that obstetrician, midwife, paediatrician would ALL attend the birth with their students! My mum and I can now laugh at the number of people squished into the delivery room but at the time it was frankly shockling. For subsequent births I made it clear only one student was allowed in the room.

@MarbleQueen

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?

Yes, someone pretending to be a nurse. This was in. Vancouver. She lied her way into quite a few nurse jobs in Canada. She has been charged.

So, so creepy and frankly upsetting.

@Redsquirrel5

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

The police are investigating and she has been charged. It has been all over our media so you can probably find it with Google,

I hope they follow up. I have been a bit creeped out and my confidence in our system has been shaken. Some other woman have been in the media but this is as public as I want to get.

I had student midwives at a couple of my appointments but I was asked (this was last year) I imagine the NHS is desperate for staff but I agree that you should always be asked your consent. I did feel like I got a bit more out of the appointments with no students but as long as they are polite I don’t mind. Them putting you off having your smear test sounds awful and shouldn’t have happened.

Just remembered, student at one of my scans too but I was asked if they could have a go scanning me.

Is it possible that this policy change has happened for your specific NHS trust? If there is a patients feedback survey maybe you can tell them how it impacted your care.

I had severe preeclampsia with my firstborn. The student obstetrician picked up on something my consultant missed. It was almost unnoticeable, but she queried my breathing, and it unlocked a chain of events that led to a different course of treatment. Yes, they’re students, but they’re being taught the latest research and techniques at university; learning that more seasoned healthcare professionals may not be aware of. If you’re not comfortable then please do speak up and ask that they leave, but be aware that at least some of them may have knowledge your HCP won’t.

I think if they ask patients if they are ok with students present before you see them, most will say no. I don’t care myself as they have got to learn. Usually I walk into the room and the consultant/doctor will say by the way we have a student observing is that ok. I remember being 16/17 and finding it awkward somebody listening to my health problems. But since then I don’t even care. I would draw the line at being observed whilst they were looking at my genitals!

Dental students don't do placement in practice, and they certainly don't do random fillings in practice. There's no need, they have specific dental hospitals with more than enough patients willing to undergo treatment by students. They are not indemnified to carry out fillings in a practice setting and neither are the practices.

A trainee is different to a student who is different to someone on work experience. Just because someond looks 17 doesn't mean they are, I have a work colleague who is frequently insinuated to be a reenter who is in fact 38.

Personally I feel anyone on a training pathway is better to see things under supervision first. And get as much experience in this heavily supervised setting before they are allowed free reign. My own experience as a student, and with other medical students as, is that the consultants paid not one iota of attention to you, and I cant imagine would do one single thing for a medical students benefit.

Also lots of people say no to medical students and I've never seen this cause a problem. We just make sure there's no medical students involved in their care, again I've not once seen a consultant give a shit bout a medical student being involved in someone's care or not. Patient says no, not a problem. There's no benefit to a qualified doctor in allowing medical students into seeing a patient, if anything many prefer there to be no student so why would they kick up a fuss about a patient saying no medical students.

[quote AutomaticMoon]@shouldistop To opt out of something you first have to be aware that it’s happening. How can people opt out when the NHS did this without telling people in the first place.[/quote]
It wasn't the NHS, it was the government, and it was all over the news. Good thing too, so people who need transplants can get them. And families are still asked, even though consent is now presumed if the person hasn't opted out. The process of change from opt in to opt out took two and a half years, was widely advertised, and there was a public consultation. But I'm sorry for you that you obviously must have missed hearing this somehow. You can opt out, it's easy, see how to in this link, the purple box at the top on the right see the choices you can make

www.organdonation.nhs.uk/uk-laws/organ-donation-law-in-england/timeline-for-max-and-keiras-law/

Quite a few years ago, after a smear test, I was summoned to the hospital, to see a male consultant, as cancerous cells were found. the consultant had to give me a more thorough examination, which was legs up and open, for him to see in detail what had to be done, but instead of the consultant alone there, he was followed in the room, by three young trainee doctors, made worse maybe, because they were all good looking, standing there in their super white medical coats, all gazing intently at the vision of me and my bits all closely in front of them all.. i didn't say anything,but was quite embarassed, as the examination was a bit painful, and couldn't wait to get my knickers on again, that were a bit lacey, and hanging on the back of a nearby chair..

I ended up having to have a smallish operation two weeks later, to remove whatever, as the consultant said it had to be done ASAP.

I’ve been both a student nurse and midwife, for clinic appointments it’s absolutely possible for the receptionist to ask or for the qualified HCP to step out of the room to meet the patient and ask permission for a student to be present (the only exception might be if the student is also acting as the chaperone for the appointment- although even then the patient should be asked and have it explained what the students role will be).

On the ward it is much more difficult, as a student nurse you are often acting as an unpaid HCA as well as a student.
I always introduced myself as a student at the beginning of the shift when we did bedside handovers but throughout the shift I’d be answering call buzzers and checking on patients alone.
Obviously I only ever did tasks that I was fully competent at and would go and get a qualified member of staff if there was something that I hadn’t been trained how to do or wasn’t confident about (and then the qualified HCP would ask if the patient was happy for me to observe/do the procedure under supervision so I could learn, but I accept that this possibly put the patient in a difficult position and will take this on board if I work clinically again).
However, on the ward most of the tasks were things like; assisting with washing and dressing, transferring a patient, helping with meals, getting things for the patient (cups of tea, snacks, passing things from their locker), taking observations (like blood pressure, temperature, pulse etc) or sitting with patients who were confused/needed 1:1 observation. Quite often these tasks require 2 people to be safe so I’d be working with a qualified nurse/midwife/HCA/physio or the task is easy but time consuming. If students weren’t doing these jobs they just wouldn’t be able to be done.
Community visits are also tricky to ask in advance because due to staffing shortages the student is often assigned to a ‘mentor’ at the beginning of a shift. If the patient has said in advance that they don’t want students then this is usually on their notes and I wouldn’t go to that appointment but most of the time the patient will need to be asked on the doorstep in front of the student (although I always made it very clear that I was happy to wait outside if they preferred and if any more sensitive/intimate examinations needed to be done then it was completely fine to ask me to leave the room).
Also, with student nurses/midwives/physios/OTs etc there tends to only be one student with the qualified HCP.
It tends to be the pre-qualification medical students who work in larger groups (usually because there are far fewer senior doctors for them to work with).
As someone else has explained ‘junior doctors’ are qualified doctors who are completing more specialist training, they’ll often provide most of the patient’s medical care but may have a Consultant discussing the patient with them at ward rounds or a more senior doctor may supervise/demonstrate more complex procedures.

Balancing the needs of students to learn, tasks to be done, and getting informed and true consent from patients is always going to pose some challenges in certain settings. However, from your experiences it’s clear that some HCPs need to do better and I have definitely reflected on my own practice in regards to this.

I had a student midwife during labour. I was not informed that she was a student. She wasn’t adequately supervised and made mistakes. She also had to get second opinions constantly which added to stress and double the internal exams. Totally not ok to have students without asking permission.

I’d also be really interested in what people’s opinions are when it’s a qualified HCP who wants to get a second opinion or support from a more experienced team member. Would you want to be asked for consent for the first HCP to stay whilst the more experienced HCP checks or supervises (e.g. a nurse sees that the patient has a pressure sore but it’s not responding to normal treatment/she’s unsure what grade it is so calls in the specialist tissue viability nurse to assess it. How would you like the first nurse to gain consent to be present to receive advice and training from the specialist?)

I'm normally accommodating of students observing or carrying out minor tasks, they have to learn after all, but have always been asked first. This was up until I was recovering from emergency surgery in hospital and a student was asked to take some blood from me. Beung very used to having bloods done I had no issue with this. She was so nervous her hands were shaking and she used me like a pin cushion before eventually someone took over, she was almost in tears afterwards. It was surprisingly traumatic, probably because I was very unwell at the time. Since then I've learned to say no if I'm the slightest bit uncomfortable, even at the presence of another person who doesn't have to be there.

Patient care should be the number one priority. If a HCP is neglecting their duty to the patient by being too focused on training the student then something is wrong.

[quote AutomaticMoon]@shouldistop I found out I’m an organ donor almost 2 years after I became one, completely unacceptable.[/quote]
It's a shame the advertising campaign seems to have passed you by. Im sure I remember adverts as far back as 2018 and certainly 2019. The adverts were called 'pass it on'. Posters in every GP surgery and hospital for years.
I'm really surprised anyone could have missed it.

Why are they not introducing themselves or the person supervising introducing them?
"Hello my name is...."
Every single person present for every single procedure where I work introduces themselves. In some instances it's appropriate for them to ask if the patient is OK them being there.

[quote HonestwithHope1]@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.[/quote]
You really do sound extraordinarily lacking in compassion and understanding of people who have experienced trauma.

I agree it is not properly teaching those training about the important of gaining informed consent.

I always (usually) say yes to students as I know how important it is for them to learn, but I HAVE to feel comfortable with it, and by definition for that to happen I have to at least be asked! It’s so shocking that you’ve had so many cases where this hasn’t happened. I would write to the trust.

I had a student midwife deliver my first baby. She was very caring. Then with my second, I had a student midwife do the delivery, she was fab and I felt very safe until she came to stitch me up and the metal tray of instruments were clanking as she walked over, she was clearly shaking. I politely asked for the senior midwife to stitch me up instead. I know students need to learn, but my gaping ripped vagina felt too important to me to let them learn on!!! I felt slightly guilty but luckily she was not offended at all and was very gracious about it.

I had a student midwife at my labour. I wasn’t asked if it was ok and she repeatedly told me the wrong thing causing me to stress out even more than I already was. After a traumatic emergency c section she stood over me and said to the other midwife how great it was for her to get to observe it, I felt like a science subject. The other midwife was experienced but brusque and largely absent. I got more care from the anaesthetist who made the experience much more calm and bearable through his demeanour.

I also had a student midwife at one of my antenatal appointments and she was lovely.