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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 Jul 19 2024
Journal Name
Baghdad Science Journal
The correlation between micro-RNA 146a and IL-17 in the serum of Iraqi patients with cystic echinococcosis
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داء المشوكات الكيسي (CE) هو مرض وبائي يسبب مرضًا خطيرًا وخسائر اقتصادية في معظم بلدان العالم. MiRNAs هي عامل جيني ضروري لتنظيم الاستجابة المناعية من خلال قدرته على التدخل في التعبير الخلوي ؛ واحد هذه الحوامض النووية الدقيقة -146 أ. هدفت الدراسة الحالية تقييم إذا كان بإمكاننا استخدام microRNA 146a كمؤشر حيوي للكشف عن    CEو تحديد العلاقة بين التعبير الجيني microRNA 146a و IL-17 في مرضى CE.حيث اشتملت الدراسة على 50 مريضًا من CE تم إد

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Publication Date
Tue Dec 02 2025
Journal Name
Journal Of Baghdad College Of Dentistry
Assessment of some salivary enzymes levels in type 2 diabetic patients with chronic periodontitis (Clinical and biochemical study)
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Background: Diabetic patients have been reported to be more susceptible to gingivitis and periodontitis than healthy subjects. Many intracellular enzymes like (alkaline phosphatase- (ALP), aspartate aminotransferase- (AST) and alanine aminotransferase- (ALT) that are released outside cells into the gingival crevicular fluid (GCF) and saliva after destruction of periodontal tissue during periodontitis. This study was conducted to determine the periodontal health status and the levels of salivary enzymes (ALP, AST and ALT) of the study and control groups and to correlate the levels of these enzymes with clinical periodontal parameters in each study group. Subjects, Materials and Methods: One hundred subjects were enrolled in the study, with a

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Publication Date
Wed Dec 30 2015
Journal Name
Al-kindy College Medical Journal
Association between glycaemic control and serum lipid profile in type 2 diabetic patients: Glycatedhaemoglobin as a dual biomarker
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Background: Patients with type 2 diabetes have an increased prevalence of lipid abnormalities, contributing to their high risk of cardiovascular diseases (CVD).Glycated hemoglobin (HbA1c) is a routinely used marker for long-term glycemic control. In accordance with its function as an indicator for the mean blood glucose level, HbA1c predicts the risk for the development of diabetic complications in diabetic patients[2].Apart from classical risk factors like dyslipidemia, HbA1c has now been regarded as an independent risk factor for (CVD) in subjects with or without diabetes.Objective The aim of this study was to find out association between glycaemic control (HbA1c as a marker) and serum lipid profile in type 2 diabetic patients.Methods

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Publication Date
Wed Sep 30 2020
Journal Name
Open Access Macedonian Journal Of Medical Sciences
The Prevalence of Myeloproliferative Disorders in A Group of Iraqi Patients And Its Relation To Blood Indices Parameters
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AIM: The aim of this study was to measure the prevalence of myeloproliferative disorders in a sample of Iraqi patients and to measure the changes in patients’ blood parameters. BACKGROUND: Myeloproliferative disorders are a group of neoplasms affecting the bone marrow progenitor cells characterized by excess cells with a risk of transforming to acute leukemia. There is a gap in knowledge about the prevalence of Iraqi population. Thus, we investigated the prevalence and distribution of different types of myeloproliferative disorders in a sample of Iraqi patients. MATERIALS AND METHODS: Cross-sectional study is done at the National Center of Hematology from November 2019 till March 2020 on 75 patients who were diagnosed

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Publication Date
Mon Aug 30 2021
Journal Name
Al-kindy College Medical Journal
Clinical Course and Disease`s Outcome Aspects of COVID-19 Pediatric Patients in Ibn Al-Khateeb Isolation Hospital
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Background: Corona virus disease 2019 (COVID-19) is a communicable disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December 2019 in Wuhan, China, and has since spread globally, leading to an ongoing pandemic.

Aim of study: to review the clinical, lab investigation and imaging techniques, in pediatric age group affected COVID-19 to help medical experts better understand and supply timely diagnosis and treatment.

Subjects and methods: this study is a retrospective descriptive clinical study. The medical records of patients were analyzed. Information’s recorded include demographic data, exposure history, symptoms, signs, laboratory findin

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Publication Date
Tue Feb 01 2022
Journal Name
Baghdad Science Journal
Association of Endothelin-I and A symmetric Dimethylarginine Levels with Insulin Resistance in Type-2 Diabetes Mellitus Patients
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Endothelin-I (ET-I) is one of the potent vasoconstrictors secreted from endothelial cells when needed. Many studies revealed the elevation of serum ET-I with human diabetes and microangiopathies. Since insulin resistance is a case of mixed diabetic and pre-diabetic cases, many risk factors beyond obesity and inflammation are proposed. The current study aims to demonstrate the association between serum ET-I and asymmetric dimethylarginine (ADMA) and insulin resistance in type 2 diabetes mellitus (T2DM). Sera of 73 subjects were enrolled currently (control= 35 subjects, and 38 with T2DM for more than 7 years), aged (40-60) years old, with distinct body mass index (BMI) ≤ 25 for control volunteers and (BMI) ≥ 25 for obesity and diabetes

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Publication Date
Fri Mar 01 2019
Journal Name
Research Journal Of Biotechnology
The etiological role of Chlamydia pneumoniae and Mycoplasma pneumoniae infections in systemic lupus erythematosus of iraqi female patients
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Recently, Systemic lupus erythematosus (SLE) was considered as one of the autoimmune diseases that the genetic and environmental factors contributed in the disease etiological profile. According to the environmental factors, infectious agents have been concluded to have a role in the etiology and pathogenesis of SLE. Chlamydia pneumoniae and Mycoplasma pneumoniae are among these infectious agents that have been suggested to be involved in the etiology of SLE. Accordingly, the current study was designed to assess the anti-C. pneumoniae and anti-M. pneumoniae IgG antibody status by enzyme linked immunosorbent assay (ELISA) in the sera of 64 Iraqi SLE females' patients and 32 Iraqi healthy females as controls. The patients' group were distribu

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Publication Date
Thu Dec 13 2018
Journal Name
Iraqi National Journal Of Nursing Specialties
Assessment of the Major Anti-Tuberculosis Drugs Available to Patients at Primary Health Care Centers in Baghdad City
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Objective: To assess the major anti-tuberculosis drugs available to patients at primary health care centers in Baghdad city. Methodology: A descriptive cross-sectional study design is carried out in order to achieve the objectives of the study by using the assessment technique in primary health care centers from December 29th, 2014 to July 10 th, 2015. probability sampling is select based on the study design. Eighteen primary health care centers are select according to criteria of sample to the study and for the purpose of the study, is select (6) sectors and (11) Primary Health Care Centers (PHCC) from Bagh

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Publication Date
Fri Dec 01 2017
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Humoral immune factor changes in group of patients with Non-muscle invasive bladder cancer treated with intravesical therapy.
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Publication Date
Sun Jun 01 2014
Journal Name
Baghdad Science Journal
Effect of Some Herbs on the Level of Some Biochemical Parameters in Blood of Diabetic Patients Type II
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This study included effect of polyherbs mixture treatment of diabetic patients type II for two months. The polyherbs mixture contains Nigella sativa seeds, Boswellia carterri gum, Citrus aurantifolia fruits, Elettaria cardamomum fruits. Also this study included estimation of some biochemical parameters in the serum Diabetes Mellitus (D.M.) patients-type II and knowing the relationship of these parameters with this disease. The parameters are glucose, cholesterol ,High density , Low density lipoproteins( HDL-C, LDL-C) respectively , Triglycerides TG, urea, total protein , albumin , Alkaline phosphatase ALP,Transaminase GOT, GPT enzymes . Take (77) samples of diabetic patients serum type II which included (47) samples for group one: herbs

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