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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
Wed May 28 2025
Journal Name
Oxidation Communications
ESTIMATION OF GALECTIN-3 IN TYPE-2 DIABETIC PATIENTS AFTER VACCINATED AGAINST COVID-19"
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The rapid spread of the COVID-19 coronavirus in 2019 infected many people, primarily affecting the respiratory system. Both COVID-19 and type 2 diabetes have been associated with numerous risks that have become life-threatening. The study studied the link between galectin levels and some clinical characteristics in Iraqis with type 2 diabetes and COVID-19 against those without diabetes. The study included 120 patients and healthy men. Three groups were formed for this study depending on the initial mutant cell line: 80 samples of individuals with type 2 diabetes, aged 40–60 years, with and without COVID-19, were included in each of the first and second groups. The control group consisted of 40 research participants who were matched for ag

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Publication Date
Tue Dec 31 2024
Journal Name
Journal Of The Faculty Of Medicine Baghdad
The Role of Microelements of Lumbar Disc Degeneration in Patients Undergoing Lumbar Spine Surgery
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Background: Lumbar disc degeneration (LDD) is a common musculoskeletal disorder that frequently causes low back pain (LBP). In addition to the discomfort of lower back pain, it can accompany pain in one or both legs. The lumbar spine and sacrum, consisting of five vertebrae and one bone, determine the spine's balance. Microelements are essential in bone metabolism and are associated with the prevention of osteoporosis and the alleviation of musculoskeletal pain. Objectives: To examine the correlation between lumbar spinal surgery and the concentrations of microelements, namely zinc and copper. Methods: A case-control study was conducted in Ghazi Al-Hariri Hospital in Baghdad, Iraq, during the period from October 2023 to January 2024

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Publication Date
Sat Sep 03 2022
Journal Name
International Journal Of Health Sciences
Correlation between oxidative stress and clopidogrel drug in Iraqi patients with coronary artery disease
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Background: Coronary Artery Disease (CAD) is one of the largest causes of mortality worldwide. Clopidogrel, antiplatelet drug, has been widely used for management of CAD. The current study aimed to investigate the effect of clopidogrel on the oxidative stress in CAD patients. Methods: One hundred CAD patients, who were followed-up for 5 days after receiving clopidogrel, and 50 healthy volunteers were included in this study. Parameters include catalase (CAT), total antioxidant capacity (TAC), total oxidant capacity (TOC), total protein, albumin, and globulins were determined before and after treatment with clopidogrel. Results: CAT, TAC, and Tp were significantly decreased (P<0.0001) in CAD patients compared to healthy control and

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Publication Date
Fri Mar 30 2018
Journal Name
International Journal Of Science And Research
The Effect of Age 0nLeptin Hormone and Some Biochemical Parameters in Patients Pre-Dialysis
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To evaluate impact the difference in stages ofage and related incidence of hemodialysis patients.Two hundred and fifty patients undergoing hemodialysis were collected from general hospital in Baghdad city /Iraq. The samples with renal failure before hemodialysis were divided into (138) male,( 112)female. The sera were separated from samples to physiological investigation. We found that renal failure was more predominant among the patients ages group ranging from (51-70) years old. The results shows A significant increase in the levels of urea, creatinine, in younger patients (≤ 30 years) when compared with older patients (>70 years). Furthermore a significant decrease in serum levels of total protein in patients in older patients (>7

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Publication Date
Fri Apr 29 2022
Journal Name
Sar Journal Of Surgery
Variation of Sphenoid Sinus Pneumatization on CT scan in A Sample of Iraqi Patients
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Background: Computerized tomography scan can show the detailed anatomy of the nose and paranasal sinuses. The sphenoid sinus is a very important corridor for the skull base because of its central position. This sinus has a great range of variation and can put structures around at risk during surgery. This study aims to examine the variation of the sphenoid sinus, and its relation to other structures around it, in this sample of Iraqi patients. Materials and Methods: CT scans of 122 patients, were obtained, and submitted for examination and measurements, during the period between September 2020 and September 2021. Observation of The sphenoid sinus pneumatization pattern, clival extension, Onodi cell, and lateral pneumatization of SS.

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Publication Date
Sun Dec 04 2016
Journal Name
Baghdad Science Journal
Biochemical Study on Anti Thyroid Peroxidase in Type 2 Diabetic patients with thyroid disorders
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Type 2 diabetes mellitus (T2DM) is the most frequent endocrinal disease commonly associated with thyroid disorders .The study is conducted at the Specialized Center for Endocrinology and Diabetes in Baghdad ,during December 2014 up to October 2015.This study was done to investigate the prevalence of anti- thyroid peroxidase (Anti-TPO) antibody in patients suffered from type 2 diabetes with thyroid disorders .The study groups included a total number of 80 subjects consisting of 60 type 2 diabetic patients divided into 20 hyperthyroidism subjects (group 1) ,20 hypothyroidism subjects (group 2), 20 euthyroidism subjects (group 3) and 20 healthy controls (group 4) . The fasting blood samples were analyzed for (T3,T4,TSH) by using Vitek Immuno d

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Publication Date
Thu Aug 01 2024
Journal Name
Al-kindy College Medical Journal
The Correlation of Serum Periostin Level with Disease Severity in Patients with Covid -19
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Background: Coronavirus disease 2019 (COVID-19) is an emerging zoonotic disease caused by the new respiratory virus SARS-CoV2. It has a tropism in the lung tissues where excess target receptors exist. Periostin plays a role in subepithelial fibrosis associated with bronchial asthma. Since the Coronavirus's target is the human respiratory system, Periostin has been recently described as a valuable new biomarker in the diagnosis and evaluation of disease in patients with COVID-19 lung involvement. Objectives: To assess the level of Periostin in the serum of COVID-19 patients and to correlate its role in disease severity and prognosis. Subjects and Methods: Periostin serum levels were measured for 63 patients attending three main COVID

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Publication Date
Fri Mar 31 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
MAGNESIUM, ZINC, AND COPPER IN SERUM, ERYTHROCYTE, URINE AND DIALYZATE FLUIDS OF HAEMODIALYSIS PATIENTS
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Copper (Cu) Zinc (Zn) and Magnesium (Mg) in serum, RBC, urine and dialyzate fluids were
studied in 39 patients, who have been undergoing chronic haemodialysis treatment. They were
divided in to polyuric , oliguric and anuric depending on their urinary output. Elevated serum and
RBC Mg was observed before dialysis, while decreased serum and RBC level was noticed except
serum Mg of polyuric patients. Before dialysis elevated serum and RBC Zn were observed. While
after dialysis these parameters were increased. Normal RBC Cu value before dialysis was observed.
While low serum Cu was noticed. After dialysis serum Cu showed raised value, while RBC level
decreased in oliguric and increased in polyuric patients. Zn / Cu rati

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Publication Date
Mon Oct 25 2021
Journal Name
Biomedicine
Serum levels of CXCL-8, IL-10, and TNF-alpha in ankylosing spondylitis patients
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The mean age of AS patients was (35.0 ± 9.8) years.When the patients and control subjects were divided into different age groups (>40, 30-40, <30 years), the differences were not significantin terms of disease prevalence. The results also showed that the percentage of male patients is higher than that of females. There was no significant difference (P?0.05) between patients and controls in the distribution of males and females.Most of the patients had the disease for a period of 5 years or higher, with a disease severity of ? 2.1 and functional disability degree of I, II. The resultsshoweddifferent patterns of distribution for the three tested cytokines. A significant increase in the level of TNF-?, anon-significantincrease i

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Publication Date
Fri Dec 22 2017
Journal Name
Pakistan Journal Of Biotechnology
THE ROLE OF HLA-DRB 1 ALLELE IN HYPOTHYROID PATIENTS WITH AND WITHOUT PERIODONTITIS
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Hypothyroidism is a frequent disorder in the general population, especially among women, is defined as adeficiency of thyroid activity that results from insufficient production or action of thyroid hormones leading to a totaldecrease of metabolic. Human leukocyte antigen is the most polymorphic genetic system in man. Genes of this regioninfluence susceptibility to certain diseases.Objectives: The purpose of the present study is to investigate the role of HLA-DRB1 genotyping in hypothyroidpatients with and without periodontitis. Sixty hypothyroid patients 30 of patients were with periodontitis and 30without periodontitis compare with 30 healthy subjects as control enrolled in this study. DNA was extracted fromblood samples, then HLA- genotyp

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