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BMJ. May 2, 1998; 316(7141): 1391.
PMCID: PMC1113092

Patients in east London seem happy to give GPs consent for training

Madeleine Gantley, Senior lecturer
Mark Rickets, Clinical lecturer
Mike Sheldon, Senior lecturer
Yvonne Carter, Professor of general practice and primary care

Editor—O’Flynn et al report a qualitative study of patients’ concerns about consent and confidentiality when students are present in consultations.1 They conclude their discussion by suggesting that patients should be given a “real choice about whether they see a student” and suggesting that explanations concerning student access to their records and discussion of their case “require further discussion.” Commenting on this conclusion in an editorial, Williamson and Wilkie recommend a move “away from a position where the patient is observed by the student and discussed afterwards to an active mode where the patient joins in discussion during the consultations.”2

General practitioners in east London, teaching small groups on junior clinical firms, have developed several strategies for seeking patients’ informed consent to and involvement in teaching. Patients were contacted before the teaching session and invited to attend at a specific time, to provide a history, and to be examined (a different style of teaching from that of the indi- vidual student “sitting in” on a surgery). Immediately before teaching, general practitioners invited patients to reiterate their consent: patients have been willing to reattend teaching sessions, which suggests active consent.

In some practices general practitioners involved patients in discussion with students after the history taking and examination but took care to address any patient concerns about the content of the discussion both immediately and on their own after the teaching. Our evaluation showed that students valued the active involvement of patients in this process.

We believe that attention to the nature of the relationship between general practitioners and patients is especially important in the light of the increasing range and volume of teaching undertaken in primary care settings. As general practitioners actively seek the help of patients their relationship shifts. The patient, in being asked to cooperate in teaching but given the explicit right to refuse, gains power. Some, when asked for their views on participating in teaching, spoke of being able to “do something” for the general practitioner or the practice; this is a rather different emphasis from that of helping with “medical education” suggested by Williamson and Wilkie. In some instances, this has been uncomfortable, presenting the possibility of patients feeling that the general practitioner is indebted to them in some way. When appropriately managed, however, such interactions can lead to a deeper, more mutually satisfactory relationship.


1. O’Flynn N, Spencer J, Jones R. Consent and confidentiality in teaching in general practice: survey of patients’ views on presence of students. BMJ. 1997;315:1138–1141. . (1 November.) [PMC free article] [PubMed]
2. Williamson C, Wilkie P. Teaching medical students in general practice: respecting patients’ rights. BMJ. 1997;315:1108–1109. . (1 November.) [PMC free article] [PubMed]

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