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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 Apr 13 2021
Journal Name
Latin American Journal Of Pharmacy
The Experience with Hospitalized COVID-19 Patients in Al-Basra, Iraq: Predictors of the disease severity
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SUMMARY. The objectives of the present study were to assess the possible predictors of COVID-19 severity and duration of hospitalization and to identify the possible correlation between patient parameters, disease severity and duration of hospitalization. The study included retrospective medical record extraction of previous coron avirus COVID-19 patients in Basra hospitals, Iraq from March 1st and May 31st, 2020. The information of the participants was investigated anonymously. All the patients’ characteristics, treatments, vital signs and laboratory tests (hematological, renal and liver function tests) were collected. The analysis was conducted using the SPSS (version 22, USA). Spearman correlation was used to measure the relations

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Publication Date
Mon Jun 15 2026
Journal Name
Journal Of Baghdad College Of Dentistry
Effects of light smoking on salivary levels of alkaline phosphatase and osteocalcin in chronic periodontitis patients
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Background: Chronic periodontitis is an inflammatory disease that affects the supporting tissues of the teeth and it’s common among adults. Smoking is an important risk factor for periodontitis induces alveolar bone loss. Alkaline phosphatase enzyme is involved in the destruction of the human periodontium. It is produced by many cells such as polymorphonuclear leukocytes, osteoblasts, macrophages and fibroblasts within the area of the periodontium and gingival crevice. Osteocalcin is one of the most abundant matrix proteins found in bones and the only matrix protein synthesized exclusively there. Smaller Osteocalcin fragments are found in areas of bone remodeling and are actually degradation products of the bone matrix.The purpose of

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Publication Date
Sun Sep 05 2010
Journal Name
Baghdad Science Journal
Chemotherapy Effects on the Activities of Some Purine Metabolic Enzymes in Sera of Ovarian Cancer Patients
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Adenosine deaminase (ADA; Ec: 3.5.4.4), 5´- Nucleotidase (5´– NT; Ec: 3.1.3.5), and AMP – amino hydrolase (AMP – deaminase AMPDA; Ec: 3.5.4.6) activities were measured in sera of ovarian cancer patients before surgery, and after chemotherapy. The results indicated that ADA specific activity increased significantly (P<0.05), while 5´-NT and AMPDA specific activity decreased significantly (P<0.05) in ovarian cancer patients before surgery in comparison with those of their corresponding control women and benign tumors groups. When the activities of these enzymes were measured after chemotherapy, a significant decrease (P<0.05) in ADA activity, and a significant increase (P<0.05) in 5´- NT and AMPDA activities w

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Publication Date
Mon Jan 01 2018
Journal Name
Current Research In Microbiology And Biotechnology
Detection of some Physiological and Immunological parameters in Iraqi clinical and subclinical hypothyroid patients: Relationship study
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The present study was performed to evaluate the level of some risk factors (biochemical and immunological) in hypothyroid Iraqi patients considering the different thyroid functional states (hypothyroidism and subclinical hypothyroidism).The study includes 82 patients clinically diagnosed with hypothyroidism. Three study groups have been investigated: (47 clinical hypothyroid patients, 12 subclinical hypothyroid patients 23 healthy individuals) of different ages. This study, show that the proportion of females (83.3 %), (87.2%) in subclinical and clinical hypothyroidisim respectively higher than the proportion of males (16.7%),(12.8%) in subclinical and clinical hypothyrodism respectively of the total patients.The majority of subclinical hyp

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Publication Date
Fri Jan 01 2021
Journal Name
Revista Latinoamericana De Hipertensión
Iatrogenic atrial septal defect post radiofrequency ablation in patients with left atrial SVT: Predictors and outcomes
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atrogenic atrial septal defect (IASD), post Catheter ablation during electrophysiological study simply can be assess with Echocardiography nowadays ablation consider the main line in the managements of patients with various type of arrhythmia. This study aims to de-termine the outcomes of Iatrogenic Atrial Septal Defect (IASD) six months post radiofrequency ablation (RF) procedure of left atrial arrhythmia using non-invasive Transtho-racic Echocardiography (TTE) parameters (LVEF, E/e` and ASD size) with sheath size as predictors of atrial septal defect closure. Patients and methods: A prospective study was con-ducted in Iraqi Centre for Heart Diseases included 47 patients post Electrophysiology procedure and ablation of left atrial SVT were

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Publication Date
Sat Oct 01 2022
Journal Name
The Egyptian Journal Of Hospital Medicine
Study on Some Parameters and Anti-Rubella Igg in A Sample of Systemic Lupus Erythematosus Patients
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Publication Date
Sat Apr 02 2022
Journal Name
Neuroquantology
The Role of Neudesin as a Novel Biomarker – in Iraqi Patients with Parkinson's Disease and Osteoporosis
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Neuron-derived neurotrophic factor [NENF], a human plasma neurotrophic factor, also increases neurotrophic activity in conjunction with Parkinson's disease-related proteins in Neudesin. Although Neudesin (neuron-derived neurotrophic secreted protein) is a member of the membrane-associated progesterone receptor (MAPR) protein subclass, it is not evolutionary related to the other members of the same family. The expression of Neudesin is found in both brain and spinal cord from embryonic stages to adulthood, as w Neudesin levels in Parkinson's patients with osteoporosis disease and Parkinson's patients without osteoporosis disease, as well as the relationship between Neudesin levels, Anthropometric and Clinical Features (Age, Gender, BMI) and

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Publication Date
Mon Jun 15 2026
Journal Name
Journal Of Baghdad College Of Dentistry
Oral manifestations, biochemical, and IL-6 analysis of saliva in major depressive disorder patients under treatment
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Background: Major depressive disorder (MDD) is mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities. The aims of the study: were to determine the prevalence of oral manifestation among patients with major depressive disorder receiving antidepressant drugs, and detect alkaline phosphatase (ALP), Total Salivary proteins (TSP), and Interleukin-6 (IL-6) in relation to MDD patients under treatment and to compare with healthy controls. Materials and method: (50) MDD patients; between the ages of 20 years and 60 years.The depression patients are divided into (25) patients under treatment with fluoxetine (Prozac), and (25) patients under tr

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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)
Evaluation of Trace Elements in Iraqi Patients with Rheumatoid Arthritis by using Atomic Absorption Spectrophotometer (AAS)
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Zinc, Copper, Selenium, Magnesium, Manganese, Chromium, Iron, Nickel, Cobalt, Vanadium and Germanium were determined by atomic absorption spectrophotometer (AAS) in blood serum of patients with rheumatoid arthritis, (30) patients (14male and 16female) with age range (37-60) years compared with normal tensive control. The analysis of results showed that the mean value of concentration (Magnesium,  Manganese and Nickel) were significantly higher in patients with rheumatoid arthritis compared to that of healthy, while the mean levels of serum (Zinc, Copper, Selenium, Chromium, Iron, Cobalt and Germanium) were significantly lower than controls. There were no significant changes in overall mean concentration of serum Vanadium in patients

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Publication Date
Sat Jul 01 2023
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Diagnostic and Predictive Values of IL-6 in a Group of Iraqi Patients with Rheumatoid Arthritis
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الخلفية: التهاب المفاصل الرَثَيَانِي أو الداء الرثياني أو الالتهاب المفصلي الروماتويدي هو مرض مزمن، من الأمراض الانضدادية التي تؤدي بالجهاز المناعي لمهاجمة المفاصل، مسببة التهابات وتدميرًا لها. ومن الممكن أيضًا أن يدمر جهاز المناعة أعضاء أخرى في الجسم مثل الرئتين والجلد. وفي بعض الحالات، يسبب المرض الإعاقة، مؤدية إلى فقدان القدرة على الحركة والإنتاجية. ويتم تشخيص المرض بواسطة تحاليل دم مخبرية مثل تحلي

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