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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
Sat Jul 08 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Estimation of Superoxide Dismutase, Matrix-metalloprotinase-9, and Interleukin -18 in Patients with Type Two Diabetes Mellitus
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Antioxidant status imbalance and inflammatory process are cooperative events involved in type 2 diabetes mellitus. This study aimed to investigate     superoxide dismutase as a potential biomarkers of antioxidant imbalance, matrix-metaloprotinase-9,   and interleukin -18  as biomarkers of inflammation in serum and to estimate  the effects of other confounding factors  gender, age and finally measuring the relation among the interested biomarkers.

This case - control study included 50 patients,   and   45 of  healthy subjects matched age –gender were also enrolled  in this study as a control group.    The   focused &nbsp

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Publication Date
Sun Sep 22 2019
Journal Name
Baghdad Science Journal
A Molecular and Biochemical Study for Cholesteryl Ester Transfer Protein (CETP) Taq1B in Iraqi Patients with Hyperlipidemia
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Cholesteryl ester transfer protein gene contains some single nucleotide polymorphisms, which have been associated with serum high-density lipoprotein concentration and other lipoproteins. This study is done for determining of cholesteryl ester transfer protein polymorphism and evaluate its effect on serum lipid profile concentrations in some hyperlipidemic patients compared with healthy subjects in Salah Al-din governorate-Iraq. Blood samples were taken from (90) patients suffering from hyperlipidemia, and (70) samples that were apparently healthy controls.  Serum lipid concentrations were measured by enzymatic assays. The polymorphism was genotyped using polymerase chain reaction restriction fragment length polymorphism analysis.&n

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Publication Date
Wed Jan 01 2020
Journal Name
Annals Of Tropical Medicine And Public Health
Role of high sensitivity C - Reactive protein and some of heavy metals in patients with rheumatoid arthritis
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Publication Date
Thu Jun 26 2025
Journal Name
Plos One
Neurologists’ perspectives on management challenges and mitigation strategies for Parkinson’s disease patients: A qualitative study in Iraq
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Background Parkinson’s disease (PD) is currently the fastest-growing neurological disorder in the world. Patients with PD face numerous challenges in managing their chronic condition, particularly in countries with scarce healthcare infrastructure. Objective This qualitative study aimed to delve into neurologists’ perspectives on challenges and gaps in the Iraqi healthcare system that influence the management of PD, as well as strategies to mitigate these obstacles. Method Semi-structured interviews were conducted with neurologists from five different Iraqi provinces, working in both hospitals and private neurology clinics, between November 2024 and January 2025. A thematic analysis approach was employed to identify the main challenge

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Publication Date
Mon Mar 01 2021
Journal Name
Journal Of Physics: Conference Series
Evaluation of total oxidant status and antioxidant capacity in sera of acute-and chronic-renal failure patients
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Abstract<p>Renal failure is a disease of the kidney, in which the renal excretory function is failed to process due to depression of the GFR. Renal failure is divided into acute and chronic depending on the period of the disease. The study was designed to investigate the level of oxidative stress in RF patients. Seventy-five subjects had enrolled in the study, who divided into three groups equally, in which they are healthy control, ARF patients, and CRF patients. The results had shown a significant <italic>(P<0.01)</italic> increase in the level of TOS for RF patients when compared with control. Also, a significant difference in the level of TOS has been observed between ARF and CR</p> ... Show More
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Publication Date
Sat Jun 01 2019
Journal Name
Collegian
Medication adherence and predictive factors in patients with cardiovascular disease: A comparison study between Australia and Iraq
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Publication Date
Sun Mar 26 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Estimation of Oxidative Stress and Some Trace Elements in Iraqi Men Patients with Type 2 Diabetes Mellitus
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Type 2 diabetes mellitus (T2DM) is a chronic disorder that is associated with the imbalance of trace elements which are involved in many functions especially enzyme activities. Changes in the levels of serum elements probably can create some complications in type 2 diabetes mellitus.  Previous experimental and clinical studies report that oxidative stress plays a major role in the pathogenesis and development of (T2DM). However, the exact mechanism of oxidative stress could contribute to and accelerate the development of (T2DM).

The aim of this study contained the following sections: firstly, to determine some biochemical parameters in subjects with type 2 diabetes mellitus (T2DM) like lipid peroxidation marker, malondialdeh

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Publication Date
Tue Nov 06 2018
Journal Name
Iraqi National Journal Of Nursing Specialties
Determination of Contributing Risk Factors to Adult Nephrolithiasis Patients
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Objectives: To determine the contributing risk factors to adult nephrolithiasis patients.
Methodology: A descriptive study was conducted to determine the contributing risk factors to
Adults nephrolithiasis starting from December 2007 to September 2008. A purposive "nonprobability"
sample of (100) patients with nephrolithiasis was selected of those who were
admitted to the hospitals, attending the Urology Consultation Clinic and Extracorporeal Shock
Wave Lithotripsy Department. The study instrument consists of two parts. The first part is
related to the patients' demographic variables and the second part is constructed to serve the
purpose of the study. The total number of items in the questionnaire was (85) ones.

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Publication Date
Sun Feb 10 2019
Journal Name
Iraqi National Journal Of Nursing Specialties
Spiritual Coping Strategies for Patients with Chronic Renal Failure
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Abstract:
Objectives: This study aims to (1) find out the association between patients' age, years of getting the disease, and their spiritual coping ability, and (2) investigate the differences in illness perception and spiritual coping ability between gender groups, level of education groups, monthly income groups, residence groups and satisfaction with health services groups.
Methodology
A descriptive correlational design is used in this study. The study sample includes a convenience sample of (158) patients with chronic kidney failure.
The study instrument consists of two parts; the first one focuses on participants’ sociodemographic characteristics, and the second part deals with participants’ spiritual coping by us

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Publication Date
Thu Nov 21 2019
Journal Name
Al-kindy College Medical Journal
Drug Resistant Epilepsy Among Patients Attended The Neurosciences Hospital
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Background: Drug resistant epilepsy is defined as failure of adequate trials of two tolerated, appropriately chosen and used antiepileptic drug schedules to achieve sustained seizure freedom. Up to 30% of patients referred to clinics with a diagnosis of pharmaco-resistant epilepsy may have been misdiagnosed, and many can be helped by optimizing their treatment.Pseudoresistance, in which seizures persist because the underlying disorder has not been adequately or appropriately treated, must be ruled out or corrected before drug treatment can be considered to have failed.

Objectives: The objectives of this study were to determine the causes of drug failure in patients with epilepsy and to differenti

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