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When Patients Say No: Rethinking Refusal in Bedside Medical Education
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ABSTRACT<sec> <title>Background

Bedside clinical teaching is a fundamental part of the medical education that offers invaluable opportunities for the students to build and improve their clinical and communication skills. However, there is a growing concern about the increasing refusal of patients to participate in clinical sessions, especially in certain settings where there are sensitive cultural traditions and decreased trust in institutions.

Aim

This paper discusses patient refusal during bedside clinical teaching and views it from three aspects, that of the medical student, the clinical educator and the patient, and proposes culturally sensitive strategies that balance patient autonomy with educational needs.

Perspective

Patient refusals reduce the students' chances of hands‐on learning, placing the educator under ethical strain and emotional fatigue. These refusals are not simply uncomfortable incidents, but they signal underlying systemic gaps such as lack of transparent communication with the patients, failure to adapt to the social development and deep cultural dissonance. While simulation offers partial relief, it cannot fully replace the human dimensions of real patient interactions.

Conclusion

Patients' reluctance is a meaningful message that needs to be heard. A thoughtful reform including coordinated efforts at the level of patient education, faculty support, student preparation and institutional policy is needed. Without reform, we risk graduating doctors who have never truly encountered the human side of medicine.

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Publication Date
Thu Nov 16 2023
Journal Name
Al-rafidain Journal Of Medical Sciences ( Issn 2789-3219 )
Evaluating TLR4 Gene Expression to Monitor Disease Progression in Iraqi Patients with Rheumatoid Arthritis
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Background: Toll-like receptors (TLRs) play a significant role in the activation of adaptive immunity and may have an essential role in the development of rheumatoid arthritis (RA). Objectives: To assess the gene expression of TLR4 in individuals with RA compared to healthy individuals. Methods: From July to December 2022. A total of 100 individuals were encompassed in the study, consisting of 50 individuals diagnosed with RA, of whom 42 were females and 8 were males, with an average age of 45.22 years. Additionally, there were 50 healthy control participants, 40 of whom were females and 10 were males, with an average age of 45.64 years. To assess the TLR4 transcript levels, blood samples were collected from each participant, and RN

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Publication Date
Fri Jul 24 2020
Journal Name
Al-kindy College Medical Journal
Speculations of Immunotherapy in COVID-19 Patients with Practical Applications During Childhood and Pregnancy
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The rapid spread of novel coronavirus disease
(COVID19) throughout the world without available
specific treatment or vaccine necessitates alternative
options to contain the disease. Historically, children
and pregnant women were considered high-risk
population of infectious diseases but rarely have been
spotlighted nowadays in the regular COVID-19
updates, may be due to low global rates of incidence,
morbidity, and mortality. However, complications did
occur in these subjects affected by COVID-19. We
aimed to explore the latest updates of
immunotherapeutic perspectives of COVID-19
patients in general population and some added details
regarding pediatric and obstetrical practice.
Immune system boo

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Publication Date
Thu Oct 01 2020
Journal Name
Biochemical And Cellular Archives
SERUM LEVELS OF GLYCERALDEHYDE-3-PHOSPHATE DEHYDROGENASE IN SAMPLE OF IRAQI PARKINSON'S DISEASE PATIENTS
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Publication Date
Wed Jan 01 2020
Journal Name
Annals Of Tropical Medicine And Public Health
The extent of UMOD gene polymorphism and its level in type 2 diabetes patients
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Publication Date
Thu Dec 01 2022
Journal Name
Baghdad Science Journal
Association of potent inflammatory Cytokine and Oxidative DNA Damage Biomarkers in Stomach cancer patients
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The infection with H. Pylori stimulates a signaling cascade that causes the generation of Cytokines and provokes Oxidative stress that is involved in the chronic inflammatory response leads to Gastric cancers. Reactive oxygen species (ROS) produce 8-Hydroxydeoxyguanosine (8-OHdG), the persistent oxidative DNA damage product. The study objective was to assess if there was a link between inflammatory cytokine levels and the presence of Oxidative DNA damage in Gastric tumor patients. In addition, evaluation of the diagnostic and prognostic value of Oxidative DNA damage and inflammatory cytokine biomarkers for Stomach cancers is being conducted. The study was accomplished on medically diagnosed Stomach cancer patients before any form of trea

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Publication Date
Wed Mar 18 2020
Journal Name
Baghdad Science Journal
Incidence of Toxoplasmosis in Psoriasis Patients and Possible Correlation with Tumor Necrosis Factor-α
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            Toxoplasma gondii is an opportunistic parasite in immune-compromised persons. The prevalence of toxoplasmosis in psoriasis patients is investigated. In addition, the treatment effect on psoriasis patients infected with toxoplasmosis through evaluating Tumor Necrosis Factor-α (TNF-α) cytokine levels is studied. Blood samples were collected from 130 individuals who involved 60 control samples and 70 samples with psoriasis. They attended Medical City Hospital in Baghdad province from October 2017 - February 2018. Then, the anti- T. gondii antibodies (IgM and IgG) and TNF- α in the sera were determined via the enzyme linked immune-sorbent assay. The highe

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Publication Date
Wed Nov 07 2018
Journal Name
Iraqi National Journal Of Nursing Specialties
Quality of Life among Adult Patients with Peptic Ulcer in the City of Sulaimani
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Objectives: To assess the quality of life for adult patients with peptic ulcers in the city of Sulaimani.
Methodology: A descriptive study, using the assessment approach was conducted on patients with peptic ulcer
disease from January 12th, 2009 to September 30th, 2009. A purposive "non-probability" sample of (100) paƟents
(males and females) with peptic ulcers who attended Kurdistan Center for Gastroenterology and Hepatology were
selected for the study. A questionnaire was adapted from the World Health Organization quality of life questionnaire
(1998) for the purpose of the study. It is comprised of (3) parts that included sociodemographic characteristics form,
medical history form and adult peptic ulcers patients' qu

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Publication Date
Fri Jul 24 2020
Journal Name
Al-kindy College Medical Journal
Speculations of Immunotherapy in COVID-19 Patients with Practical Applications During Childhood and Pregnancy
...Show More Authors

The rapid spread of novel coronavirus disease(COVID19) throughout the world without availablespecific treatment or vaccine necessitates alternativeoptions to contain the disease. Historically, childrenand pregnant women were considered high-riskpopulation of infectious diseases but rarely have beenspotlighted nowadays in the regular COVID-19updates, may be due to low global rates of incidence,morbidity, and mortality. However, complications didoccur in these subjects affected by COVID-19. Weaimed to explore the latest updates ofimmunotherapeutic perspectives of COVID-19patients in general population and some added detailsregarding pediatric and obstetrical practice.Immune system boosting strategy is one of therecently emerging issue

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Publication Date
Sat Mar 04 2017
Journal Name
Baghdad Science Journal
Measurement and purification of Alanine aminotransferase (ALT) enzyme activity in patients with celiac disease
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Celiac disease (CD) is the most common genetically - based disease in correlation with food intolerance. The aim of this study is to measure the activity of ALT enzyme and purify enzyme from sera women with celiac disease. Alanine aminotransferase (ALT) activity has been assayed in (30) women serum samples with celiac disease, age range between (20-40) year and (30) serum of healthy women as control group, age range between (22-38) year. In the present study, the mean value of ALT activity was significantly higher in patients with celiac disease than healthy group (p<0.01). The ALT enzyme was partial purified from sera women with celiac disease by dialysis, gel filtration using Sephadex G- 50 and ion exchange chromatography using DEAE- cell

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Publication Date
Sun Nov 01 2020
Journal Name
Pakistan Journal Of Medical And Health Sciences
Impact of smoking on cardiac electrophysiological parameters of symptomatic sinus node patients in Iraq
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Background: Dysfunction of sinoatrial node is a set of abnormal rhythms which are resulted from the sinoatrial node malfunction of the sinus node, the chief natural cardiac pacemaker. The common, and occasionally, the single method for treatment of heart arrhythmias was implantation of pacemaker, which reduce symptoms exactly occurs after implantation. Aim: To detect the role of smoking on cardiac electrophysiology parameters in sinus node dysfunction in Iraqi patients such as SNRT and AH. Methods: A cross sectional study, was conducted on 59 patient ranging between 20-50 years old and involving 35 female and 24 male patients, suffering from an unexplained symptoms of sinoatrial node dysfunction (SND). The enrolled participants were gathere

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