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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 Apr 01 2021
Journal Name
Biochemical And Cellular Archives
STUDY OF LYSYL OXIDASE-1 AND KIDNEY FUNCTION IN SERA OF IRAQI PATIENTS WITH DIABETIC NEPHROPATHY
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This study aimed to compare lysyl oxidase-1 level in diabetic patients with and without renal dysfunction, that LOX-1 may be an indicator for the early stage of diabetic nephropathy (DN). In addition to finding it is a relationship with kidney functions in Iraqi diabetic patients with and without renal dysfunction. Blood was obtained from 25 healthy individuals as a control group (G1), 25 diabetic patients with renal dysfunction, and 25 diabetic patients without renal dysfunction. Age range 40-60 years for all subjects. BMI (25-27) Kg/m2 . The serum was used for the analysis of LOX-1, FBG, urea, creatinine and uric acid. Whole blood is used for the determination of HbA1C. Results of FBG and HbA1C revealed a significant increase in G2 and G

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Publication Date
Sat Jun 30 2012
Journal Name
Al-kindy College Medical Journal
Erythrocyte Magnesium Levels in type I and type II Iraq diabetic patients effect of antidiabetic treatment
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Background: Direct measurement of intracellular magnesium using erythrocytes has been suggested as a sensitive indicator for the estimation of body magnesium store. Marked depletion in plasma and erythrocyte magnesium levels was particularly evident in diabetic patients with advanced retinopathy and poor diabetic control. While insulin has been shown to stimulate erythrocyte magnesium uptake, hyperglycemia per se suppressed intracellular magnesium in normal human red cells.
Aim of the study: To investigate the erythrocyte magnesium level in Iraqi type I and II diabetic patients, with specific emphasis on the effect of both, metabolic control and the type of antidiabetic treatments.
Methods: Sixty two diabetic patients (7 with type

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Publication Date
Tue Mar 28 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Association of Admission Serum Resistin Level with Acute ST-Segment Elevation Myocardial Infarction in Iraqi Patients
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Human resistin is an adipokine, with a possible link to coronary heart disease.A few studies were done about resistin in acute phase of ST-segment elevation myocardial infarction (STEMI) especially in Iraqi patients. Accordingly we design a study to investigate the association between resistin concentration and acute phase of STEMI in Iraqi patients.

The present study was carried out at Al-Yarmouk Teaching Hospital from December 2011 until June 2012. Serum resistin levels were measured in 50 patients with acute STEMI (mean age: 58.16 ± 11.73 years) at the first 12 hours of admission and 34 normal controls (mean age: 53.98 ± 15.46 years) matched for age, sex and other risk factors.

 Resistin level in patients wi

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Publication Date
Tue Sep 26 2017
Journal Name
The Gulf Journal Of Oncology
Effects of cranberry-PACs against urinary problems associated with radiotherapy in iraqi patients with bladder carcinoma
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Publication Date
Sun Jan 01 2023
Journal Name
Iraqi Journal Of Hematology
Comparison of circulating matrix metalloproteinase-2 levels in untreated acute myeloid leukemia patients with remission status
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The study aimed to evaluate the level of MMP‑2 in acute myeloid leukemia (AML) patients in comparison with that in remission status, and healthy subjects, and to find its correlation with hematologic parameters. This study included sixty newly diagnosed AML patients. Remission status was assessed after induction chemotherapy. The overall survival (OS) was determined after 6 months. The plasma MMP‑2 level was measured at diagnosis by enzyme immunoassay. Twenty‑eight healthy individuals were recruited as a control group. Plasma MMP‑2 was higher in AML patients than in healthy individuals (P = 0.005). The level of MMP‑2 was much higher in the M5 subtype than in the other subtypes (P = 0.0001). There was no statistically significant d

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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)
Effects of Losartan versus Enalapril on Serum Uric Acid Levels in Hypertensive Patients with Metabolic Syndrome
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To investigate the effects of losartan and enalapril on serum uric acid in hypertensive patients with metabolic syndrome, one hundred and twenty six newly diagnosed mild hypertensive patients, having markers of metabolic syndrome included  in the study. The patients were divided into two groups. Group 1 (60 patients) was given losartan (50 mg/ day) and group 2 (66 patients)  enalapril (20 mg/ day) for a duration of 2 months. A control group of seventy apparently healthy individuals were included. Metabolic syndrome was diagnosed according to diagnostic criteria of metabolic syndrome related to the American National Cholesterol Education Program-Adult Treatment Panel III. Serum uric acid levels were measured bef

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Publication Date
Fri Dec 30 2011
Journal Name
Al-kindy College Medical Journal
None anticipated bacterial urinary tract infections in type 2 diabetic patients relative to duration and angiopathies
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Background: Diabetes mellitus is a well
known metabolic and vascular illness associated
with high incidence of bacterial urinary tract
infections especially in diabetic complications
including both micro and macro-vascular types.
Objective: To study the incidence of bacterial
urinary tract infections in type 2 diabetic
patients, the type of micro-organism responsible
in relation to age, sex of patients, duration of the
disease & related micro & macrovascular
diabetic complications.
Methods: A prospective study of the diabetic
patients including 40 males with mean age of
54(±9) years and 50 females, mean age of 51(±7)
years and duration of the and sex matched
controls (27 males and 33

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Publication Date
Sun Dec 07 2014
Journal Name
Baghdad Science Journal
The level of IL-1?, IL-10 and IL-17A in Alzheimer's disease patients: Comparative study
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The objective of this study is to evaluate the level of cytokines IL-1?, IL-10 and IL-17A in the serum of patients with Alzheimer's disease (AD), vascular dementia (VD) and down syndrome (DS). The results showed that Serum level of IL-1? was significantly increased in AD patients (3.79 ± 0.26 pg/ml) as compared with DS patients (2.78 ± 0.39 pg/ml) or controls (2.78 ± 0.22 pg/ml), while no significant difference was observed between AD and VD (3.25 ± 0.20 pg/ml) patients or between VD patients, DS patients and controls. The serum level of IL-10 was approximated in VD and DS patients and controls (3.39 ± 0.24, 2.77 ± 0.39 and 3.41 ± 0.35 pg/ml, respectively), but was significantly (P ? 0.05) increased in AD patients (5.73 ± 0.55 pg/ml

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Publication Date
Wed Apr 12 2023
Journal Name
Iraqi Postgraduate Medical Journal
The Accuracy of Electrocardiographic Criteria for Predicting Left Ventricular Hypertrophy in adult Patients with Systemic Hypertension
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ABSTRACT: BACKGROUND: Left ventricular hypertrophy is a significant risk factor for cardiovascular complications such as ischemic heart disease, heart failure, sudden death, atrial fibrillation, and stroke. A proper non-expensive tool is required for detection of this pathology. Different electrocardiographic (ECG) criteria were investigated; however, the results were conflicting regarding the accuracy of these criteria. OBJECTIVE: To assess the accuracy of three electrocardiographic criteria in diagnosis of left ventricular hypertrophy in adult patients with hypertension using echocardiography as a reference test. PATIENTS AND METHODS: This is a hospital-based cross sectional observational study which included 340 adult patients with a his

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Publication Date
Tue Apr 01 2025
Journal Name
Journal Of Nature And Science Of Medicine
Examining of Predictive Factors for Developing Gastroduodenal Ulcer among Patients Attending Gastrointestinal Teaching Hospitals in Baghdad
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Background and Objectives:

Duodenal and gastric ulcers remain the two most common perforations of the gastrointestinal tract and might be reduced by the early detection of predictive factors, which has limitedly researched. This study conducted to examine the predictive factors for developing of gastroduodenal ulcer among patients attending Gastrointestinal Teaching Hospitals in Baghdad, Iraq.

Materials and Methods:

A cross-sectional survey with a total of 100 patients with gastric and duodenal ulcers was recruited using a nonprobability (purposive) sampling techniqu

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