Getting consent when observing patients

A medical student found herself the subject of a patient complaint after she had observed during an examination by a consultant neurologist.

The patient lodged a complaint because he had not given permission for the student to be present during the consultation and felt confidentiality had been breached. The student thought that the consultant had obtained the patient's consent beforehand, and the patient did not raise any objections during the consultation. She contacted the MDU to help her to prepare a statement for the hospital complaints manager, and for advice on observing patients in future.

MDU advice

The MDU adviser discussed what had happened and agreed that the best approach was to provide a factual account of the examination, and to make it clear that the patient had at no time voiced concern about her presence. The adviser also suggested that the student apologised and explained that she had assumed the patient had given consent before entering the room.

It is the examining doctor's responsibility to seek consent for a student to observe or examine a patient. If a patient is happy for a student to observe, it is usual for the doctor to introduce them to the patient and explain why they are there. However, to avoid a situation like this one, students can also introduce themselves and check that the patient is happy for them to observe.

The GMC's guidance Consent: patients and doctors making decisions together (2008) lists the type of information patients need to know before deciding whether to consent to treatment or an investigation. This includes "the people who will be mainly responsible for and involved in their care, what their roles are, and to what extent students may be involved". The patient can object to a student's presence and, if they do so, it will not affect the treatment they receive.

Occasionally - usually with intimate examinations - patients may give consent for a student to observe and then subsequently change their mind. If this happens, you should accept the patient's wishes and leave the room immediately.

This guidance was correct at publication 12/12/2014. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

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