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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
Tue Jan 01 2019
Journal Name
Journal Of Pharmaceutical Sciences & Research
Evaluation of Oxidative Stress and Some Vitamins as Antioxidants in Type2 Diabetic and Nephropathic Patients.
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Background: The present study involved the following parts, the first part is evaluation of the levels of glycated hemoglobin(HbA1c), creatinine, uric acid(UA) and albumin in patients with diabetic nephropathy comparison with the group of healthy as a control group. The second part is the measurement and evaluation of oxidative stress represented in the malondihydehyde(MDA) as a biomarker of oxidative stress as well as the identification of vitamins C and E as an antioxidant in patients with diabetic nephropathy(DN) compared with the healthy group. Objective: The objective of this study is to estimate oxidative stress by calculate malondialdehyd as biomarker and evaluate some vitamins such as vit C and vit E as antioxidants in diabetic neph

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Publication Date
Sun Mar 06 2016
Journal Name
Baghdad Science Journal
Association of Glutathione–S-Transferase (GSTP1) Genetic Polymorphism in Iraqi Patients with Diabetes Mellitus Type2
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Glutathione S-transferases (GSTs) are enzymes that included, in a more range of detoxifying reactions by conjugation of glutathione, to electrophilic material. Polymorphisms n the genes that responsible of GSTs affect, the function of the GSTs. GSTs play an active role in protection of cell against oxidative stress mechanism. Polymorphisms of GSTP1 at codon 105 amino acids forms GSTP1 important site for bind of hydrophobic electrophiles and the substitution of Ile/Val affect substrate specially catalytic activity of the enzyme and may correlate with reach to different diseases in human like diabetes mellitus type2 disease. Correlation between these polymorphisms and changes in the parameters file of diabetic patients has also bee

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Publication Date
Fri Jan 20 2023
Journal Name
Ibn Al-haitham Journal For Pure And Applied Sciences
Evaluation of Osteocalcin and Some Biochemical Marker in Diabetes Mellitus Iraqi Women's patients with Osteoporosis
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Diabetes mellitus is a set of metabolic diseases, the most prevalent of which is chronic hyperglycemia. The culprits include insulin synthesis, insulin action, or both. Osteoporosis is a progressive systemic skeletal disorder defined by decreased bone mass and micro architectural degeneration of bone tissue, resulting in increased bone fragility and fracture risk, according to the World Health Organization (WHO). The degree of Nervosa damage determines how much a diabetic patient's body has been compromised. The current study's goal is an estimation: Age, BMI, FBS, HbA1C, D3, ALP, Ca, P, and Osteocalcin in Iraqi T2DM Women's patients with and without Osteoporosis. Three vitamins are required for Osteocalcin biosynthesis: vitamin K for Gla f

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Publication Date
Tue Oct 01 2024
Journal Name
Journal Of Obstetrics Gynecology And Cancer Research
Comparison of Levels of Activin A and Follistatin in Ectopic Pregnancies and Missed Abortions Patients
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Publication Date
Wed Apr 01 2020
Journal Name
The Egyptian Rheumatologist
Predictive significance of CXCL8, CXCL10 and CXCL16 in juvenile idiopathic and rheumatoid arthritis Iraqi patients
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Publication Date
Thu Mar 30 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
The Role of Chloroquine Phosphate on Acute Phase Reactant Proteins in Patients with Knee Osteoarthritis
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The acute phase response is a major pathophysiologic phenomenon that accompanies inflammation whether acute or chronic. Complement (C3 and C4) and C - reactive protein (CRP) are positive acute phase proteins (+ ve APPs ). Their production takes place in hepatocyte and the blood concentration of these parameters are increased in osteoarthritis (OA). Chloroquine (CQ) is a diprotic weak base traditionally used to treat malaria. Recently the phosphate salt of CQ is used to decrease this type of (+ve APPs) . In this study,  patients who suffered from knee osteoarthritis (KOA) are treated with oral dosage form of chloroquine phosphate (CQP) for one month, twice daily. Our results demonstrate that CQP improves the patient status by decreas

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Publication Date
Fri Dec 01 2023
Journal Name
Baghdad Science Journal
Gene Expression and Methylation Levels of PCSK9 Gene in Iraqi Patients with Coronary Artery Disease
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The expression of the Proprotein Convertase Subtilisin/Kexin Type 9 gene (PCSK9) is inextricably related to lipid levels and a risk of atherosclerotic coronary artery disease (ASCAD). The present study aims to measure the quantity of PCSK9 gene expression and the effect of methylation on its expression level taking part in the pathogenesis of acute coronary artery disorder.

A current study included 150 subjects from the Iraqi population, 100 ASCAD patients and 50 healthy controls. The concentration of PCSK9 in each serum sample was determined by the ELISA technique, the expression levels of the PCSK9 gene in whole blood were estimated by RT-qPCR – Quantitative Reverse Transcription PCR method, and DNA

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Publication Date
Wed Jan 01 2025
Journal Name
Medical Journal Of Babylon
Study Effect of Periostin Level in Obese Iraqi Females Patients with Type 2 Diabetes Mellitus
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Abstract<sec> <title>Background:

Obesity has been connected to a higher risk of acquiring a number of diseases, including cancer, type 2 diabetes mellitus (T2DM), hypertension, and cardiovascular disease. Periostin is a crucial regulator of the growth and maintenance of bones, teeth, and the heart.

Objectives:

The aim of the study was to estimate the level of (periostin, glycated hemoglobin [HbA1c], fasting serum [FBG], total cholesterol [TC], high-density lipoprotein [HDL], low-density lipoprotein [LDL], and triglycerides [TG]) in diabetic Ira

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Publication Date
Sun Jun 03 2018
Journal Name
Baghdad Science Journal
Gene Expression and Polymorphism of Interleukin-4 in a Sample of Iraqi Rheumatoid Arthritis Patients
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It was aimed to understand the interleukin-4 (IL-4) role in etio-pathogenesis of rheumatoid arthritis (RA). Two approaches were adopted. In the first one, a quantitative expression of IL4 gene was assessed by reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and such findings were correlated with some demographic, clinical and laboratory parameters, which included gender, duration of disease, disease activity score (DAS-28), rheumatoid factors (RFs), C-reactive protein (CRP) and anti-cyclic citrullinated peptide (ACCP) antibodies. In the second approach, a single nucleotide polymorphism (SNP) of IL4 gene (rs2243250) was inspected by DNA sequencing using specific primers. Fifty-one Iraqi RA patients (22 males and 29 fem

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Publication Date
Sun Jun 01 2014
Journal Name
Baghdad Science Journal
Evaluation of protein level’s changes in saliva and sera of Oral Squamous Cell Carcinoma patients
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This study aimed to identify the changes in total protein in saliva and sera samples of patients with oral squamous cell carcinoma in comparison to those of healthy controls. These changes were followed using electrophoresis (PAGE). Meanwhile, determinations of albumin, globulin and albumin to globulin ratio were carried out on sera samples only.Two groups were the participants in the present study, 18 patients with Oral Squamous Cell Carcinoma (OSCC), and 20 ages and gender matched healthy controls.

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