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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
Fri Jun 12 2026
Journal Name
Journal Of Baghdad College Of Dentistry
Correlation between crevicular C-reactive protein level with its serum level in chronic periodontitis patients
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Background: The main purpose of this study is to find if there is any correlation between the level of C-reactive protein (CRP) in gingival crevicular fluid with its serum level in chronic periodontitis patients and to explore the differences between them according to the probing depth. Materials and methods: Forty seven male subjects enrolled in this study. Thirty males with chronic periodontitis considered as study group whom further subdivided according to probing depth into subgroup 1 with pocket depth ≤6mm, subgroup 2 with pocket depth >6mm. The other 17 subjects considered as controls. For all subjects, clinical examination where done for periodontal parameters plaque index (PLI), gingival index (GI), bleeding on probing (BOP),

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Publication Date
Tue Jun 30 2015
Journal Name
Al-kindy College Medical Journal
The prevalence and antimicrobial resistance of Pseudomonas species in patients with chronic suppurative otitis media
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Background: Chronic suppurative otitis media (CSOM) is the result of an initial episode of acute otitis media and is characterized by a persistent discharge from the middle ear through a tympanic perforation for at least 2 weeks duration. It is an important cause of preventable hearing loss, particularly in the developing world.Objective: To get an overview on the bacterial ear infection profile in general and to assess the antibiotic resistance of Pseudomonal infection (PS) particularly since it is usually the commonest infection to cause otitis media and the most difficult to treat due to the problem of multi drug resistance..Methods: A cross sectional study was done which included 405 patients of CSOM patients, 196 (48%) case were mal

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Publication Date
Sun Oct 01 2023
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Atherogenic Indices in Type 2 Diabetic Iraqi Patients and Its Association with Cardiovascular Disease Risk
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خلفية البحث: مرض السكري هو عامل خطر لأمراض القلب والأوعية الدموية وتصلب الشرايين وسبب مهم للوفاة. يرتبط خلل الدهون في الدم بشكل شائع بمرض السكري من النوع الثاني ويعتبر مؤشر تصلب الشرايين في البلازما علامة قوية للتنبؤ بخطر الإصابة بتصلب الشرايين وأمراض القلب التاجية. الهدف من البحث: دراسة ارتباط المؤشرات الدهنية لتصلب الشرايين لدى المرضى العراقيين المصابين بالسكري من النوع الثاني ولديهم أمراض قلبية وعائ

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Publication Date
Tue Dec 26 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Belief about Medications Among Type 2 Diabetic Patients Attending the National Diabetes Center in Iraq.
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Diabetes mellitus is a common health problem worldwide counting about 1.2 million cases in Iraq in 2015. Taking in account of the patient’s beliefs about the prescribed medication had been reported to be one of the most important factors that affects adherence where holding positive beliefs about medications is a prerequisite for intentional adherence. The aim of the current study was to investigate and assess beliefs about medicines among type 2 diabetic patients and to determine possible association between this belief and glycemic control as well as some patient-specific factors. This study is a cross-sectional study carried out on 380 (mean age 56.58± 10.06 years) already diagnosed T2DM patients who attended the National Diabetes

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Publication Date
Sun Dec 01 2002
Journal Name
Iraqi Journal Of Physics
The Role of Plasm Lipid Profile on RBC Aggregation and Sedimentation Changes in Diabetic Patients
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The aggregation capacity of human reb blood cells lies between that of the non- aggregated arythrocyte and the remarkably full sedimentation. As the ability to aggregate is atributed to many factors such as the availability of macromolecules and plasma lipids, the role of plasm lipid profile on RBC aggregation and sedimentation changes in normal and diabetic patients is studied.Also serum lipid profile measurement (Total cholesterol, Triglyceride, HDL, LDL, VLDL) in normal and diabetic subjects were made. The principle of measurement includes detecting the transmitted laser light through a suspension of 10% diluted red blood cells in plasma. In all diabetics, the raulux formation and sedimentation rate is enhanced.

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Publication Date
Wed Mar 29 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
The Correlation between Serum Total Adiponectin and Hemoglobin in Type 2 Diabetic Patients without Microalbuminuria
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Low serum total adiponectin is associated with a high incidence of type 2 diabetes or coronary artery disease in the general population. Paradoxically, serum total adiponectin is elevated in patients with chronic kidney disease (CKD), such as overt diabetic nephropathy. The current study aimed to investigate whether or not  anemia to be dependently associated with serum level of total adiponectin in  non-albuminuric male patients with type 2 diabetes . The study included 42 type 2 diabetic male patients. Anemia was defined as hemoglobin (Hb) below 14.0g/dL. All the patients were without microalbuminuria, to exclude diabetic nephropathy. The diabetic patients were divided into 2 groups according to the hemoglobin level in ad

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Publication Date
Sun Dec 30 2012
Journal Name
Al-kindy College Medical Journal
Assessment of High Sensitivity C.Reactive Protein in male patients with metabolic syndrome and atherosclerosis complications
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Background: syndrome X or metabolic syndrome is a collection of multiple diseases mainly visceral obesity , hypertriglyceridemia , decrease HDL level, hypertension and elevated fasting blood glucose that lead to accelerated atherosclerosis through multiple mechanisms, one of the most important is increase inflammation of the vessels manifested by elevated high sensitivity C reactive protein (hs-CRP).Objective: The aim of the study was to assess the prevalence of elevatedhs CRP in people with metabolic syndrome and atherosclerosis complication (IHD, Cerebrovascular disease, peripheral vascular disease) and metabolic syndrome without these complication.Patients and methods:;This is a cross sectional study carried out in Diabetic referral c

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Publication Date
Thu Aug 27 2020
Journal Name
European Journal Of Ophthalmology
Comparison of corneal epithelial thickness profile in dry eye patients, keratoconus suspect, and healthy eyes
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Purpose:

To compare the corneal epithelial thickness profile in patients with dry eyes and keratoconus suspect with normal healthy eyes.

Methods:

The study involved 120 eyes with an age range from 19 to 30 years. Forty eyes had normal corneal topography and no dry eyes. Forty eyes had dry eyes but had normal corneal topography. The last 40 eyes were keratoconus suspect and had no symptoms or signs of dry eyes.

Results:

Central epithelial thickness was not different statistically for all eyes. ( p-value: 0.1). The superior epithelial thickness was 53.5 µm ±3.1 in the control

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Publication Date
Mon Jun 15 2020
Journal Name
Journal Of Baghdad College Of Dentistry
Effect of different bracket types on streptococcus mutans count in orthodontic patients using fluoridated toothpaste
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Background: Plaque retention during fixed orthodontic therapy is an important cause of developing enamel demineralization. The purpose of this study was to evaluate the effect of different brackets types on the count of Streptococcus Mutans in orthodontic patients using conventional fluoridated toothpaste. Materials and Methods: Plaque samples were collected from maxillary 1st premolar teeth of twenty right handed patients (using split mouth technique) before bonding, after 48 hrs of bonding using tooth brush only, and after 2 weeks of using fluoridated toothpaste. Stainless steel bracket was bonded on right first premolar while the left one was bonded with sapphire bracket. The calculation of the Streptococcus Mutans count was done usin

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Publication Date
Sun Dec 27 2020
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Estimation of Beta Two Microglobulins, Fetuin-A, Resistin Serum Level in Iraqi Multiple Myeloma Patients
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Multiple myeloma is hematological disease produces many complications in the bone, kidney, neural and other complications. The study aims to measure serum biomolecules like fetuin-A and resistin and determined the possibility to use these biomarkers as disease predictor. blood samples were isolated from 58 patients and 24 sex and age-matched control, serum then isolated, and proper ELISA kit then used to a determined level of B2 microglobulin, resistin, and fetuin-A. The result demonstrated significant increase in   B2 microglobulin, fetuin-A and resistin in patients compare to control (1.3470.714 vs. 0.9130.253), p = 0.000, (14.00310.352 vs. 9.2594.264), p= 0.005, (1.9673.595 vs. 0.6040.622), p = 0.009, respectively. &

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