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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 Mar 30 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
The Effect of Long Term use of Glibenclamide on Serum and Urinary Sodium and Potassium Level in Type 2 DM Patients
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         Long-term use of sulfonylureas including chlorpropamide, is known to potentiate the antidiuretic action of arginine vasopressin (AVP), predisposing to hyponatremia.The present study was designed to evaluate the effect of long term use of glibenclamide on serum and urinary levels of sodium and potassium in Type 2 DM patients in Iraqi DM centers. Ninety eight patients with Type 2 DM who were maintained on different doses of glibenclamide for at least 1 year, attending the centre for Diabetes and Endocrinology in Al-Rusafa, Baghdad, were enrolled in the study, in addition to 15 normal healthy subjects. Patients were allocated into three groups according to the dose of glibenc

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Publication Date
Wed Sep 14 2016
Journal Name
Journal Of Baghdad College Of Dentistry
Evaluation of Systemic C-reactive Protein as a Systemic Inflammatory Marker in the Blood for Patients Undergoing Minor Oral Surgical Procedures
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Background: C-reactive protein (CRP) is an acute phase protein that its plasma levels increase after trauma or surgery so it is used as an indicator for the level of inflammation after surgery. The objective of this study is to investigate pre- and post-operative levels of CRP in three types of oral surgical interventions (Apicoectomy, Impaction, and Impacted teeth exposure). Materials and Methods: A total number of (48) healthy individuals aged (20-60) years who needed oral surgical intervention for either (removal of impacted third molars, exposure of an impacted canine, or Apicoectomy). A 4ml venous blood was obtained from each patient at two occasions (pre-operatively at the day of operation and post-operatively after 48 hours), then ce

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Publication Date
Mon Jul 01 2024
Journal Name
Journal Of The Faculty Of Medicine Baghdad
The Burden of Chronic Obstructive Pulmonary Disease COPD in Stable Patients and its Association with Inflammatory Biomarkers and Body Mass Index
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Background: Chronic obstructive pulmonary disease (COPD) is a progressive airflow limitation that is preventable but not curable. It is associated with persistent symptoms that cause a considerable burden on individual productivity at work, and daily activities, and reduced quality of life, also burdening the healthcare system and society. Objectives: The study aims to measure the burden of COPD on patients in terms of daily activities and work productivity. It also seeks to investigate some inflammatory biomarkers' levels and their correlation with selected outcomes. Patients and Methods: A cross-sectional study on 120 stable COPD patients who were diagnosed and treated according to the GOLD guidelines at Kirkuk General Hospital's

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Publication Date
Wed Dec 14 2016
Journal Name
Journal Of Baghdad College Of Dentistry
Oral Health Status among Group of Patients with Juvenile Idiopathic Arthritis According to Duration of Illness and Age Group in Iraq
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Background: Juvenile idiopathic arthritis (JIA) is a chronic disease of childhood. Increased prevalence of periodontal disease and dental caries in juvenile idiopathic arthritis is due to difficulties in executing good oral hygiene. This study was conducted to assess oral health status in patients with Juvenile idiopathic arthritis according to age and duration of illness. Materials and methods: A research was conducted among Juvenile idiopathic arthritis patients attending Baghdad Teaching Hospital with different age and both gender, underwent a clinical evaluation of their dental and oral condition. Diagnosis of dental caries was done according to the criteria of WHO (1997). Dental plaque, gingival condition, calculus were assessed by PI/

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Publication Date
Tue Jan 01 2019
Journal Name
Indian Journal Of Public Health Research &amp; Development
Predictive Value of Spectral Waveform Indices; Intimal Medial Thickness and Lumen Diameter of Carotid Artery in Iraqi Diabetic and Hypertensive Patients
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Background: Diabetes and hypertension are related to cardiovascular risk factors and are possible to detect development of atherosclerosis in cardiovascular system, were can predict their effect and measurement by ultrasound and Doppler study. These risk factors included increased intima-media thickness, resistive index (RI) and pulsatility index (PI) of the right common carotid arteries. Method: We studied 20 patients with diabetes and hypertension, and 20 patients with diabetes only, were examine right carotid arteries for these two groups. In this sample we studied the Lumen diameter of the Rt. carotid arteries, Intima – media thickness (IMT), peak systolic velocity, end diastolic velocity, and Pulsatility index, Resistance index were

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Publication Date
Sat Jun 30 2012
Journal Name
Al-kindy College Medical Journal
The Detection of Silent Celiac Disease In patients With Type 1 Diabetes Mellitus by the use of Anti Tissue Transglutaminase Antibodies
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Objective: Detection the presumptive prevalence of
silent celiac disease in patients with type 1 diabetes
mellitus with determination of which gender more
likely to be affected.
Methods: One hundred twenty asymptomatic patients
[75 male , 45 female] with type 1 diabetes mellitus
with mean age ± SD of 11.25 ± 2.85 year where
included in the study . All subjects were serologically
screened for the presence of anti-tissue transglutaminase
IgA antibodies (anti-tTG antibodies) by Enzyme-
Linked Immunosorbent Assay (ELISA) & total IgA
was also measured for all using radial
immunodiffusion plate . Anti-tissue transglutaminase
IgG was selectively done for patients who were
expressing negative anti-

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Publication Date
Tue Dec 02 2025
Journal Name
Journal Of Baghdad College Of Dentistry
The study of tempromandibular joint disorders and anti-cyclic citrullinated peptide antibodies in serum and saliva of patients with rheumatoid arthritis
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Background: Rheumatoid arthritis is an autoimmune disease that affects mainly the synovial membranes and articular structures and is characterized by chronic, systemic inflammation involving multiple joints.Being a synovial joint, the Temporomandibular Joint is subject to the same disorders affecting other synovial joints, including RA.Beside it was considered as a specific serological marker for diagnosing RA disease ,antibodies to cyclic citrullinated peptide have proven to be associated with joints destruction, though; it may play a potential role in the prediction of the disease severity. Materials and Methods: Sixty nine individuals (69) were enrolled in this study, forty nine (49) were patients diagnosed with Rheumatoid Arthritis, a

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Publication Date
Wed Sep 02 2020
Journal Name
International Journal Of Pharmaceutical Research
A Study of Anti-Fungal Activity for Some Antibiotics Against Aspergillus spp. and Candida spp. in Iraqi patients with Diabetes Mellitus
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Publication Date
Sun Dec 07 2014
Journal Name
Baghdad Science Journal
Genotypic Study of Two Virulence Factors fimH and kpsMTII in Uropathogenic Escherichia coli Isolates from Children Patients with Urinary Tract Infections
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Adhesion (type 1 fimbriae) and host defense avoidance mechanisms (capsule or lipopolysaccharide) have been shown to be prevalent in Escherichia coli isolates associated with urinary tract infections. In this work, 50 uropathogenic Escherichia coli (UPEC) isolated from children with urinary tract infections were genotypically characterized by polymerase chain reaction (PCR) assay. We used two genes; fimH and kpsMTII, both of them previously identified in uropathogenic E.coli (UPEC) isolates. The PCR assay results identified fimH (90.0)% and kpsMTII (72.0)% isolates. In the present study, was also demonstrated that these genes may be included in both or one of them within a single isolate.

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Publication Date
Wed Dec 30 2015
Journal Name
Al-kindy College Medical Journal
Estimation Of Left Ventricular Ejection Fraction Using Mitral Annular Displacement Derived By Speckle Tracking Echocardiography In Patients With Different Heart Diseases
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Background: Speckle tracking echocardiography (STE)-derived mitral annular displacement (MAD) utilizes the speckle tracking technique to measure strain vectors, which provides accurate estimates of left ventricular ejection fraction (LVEF).Objectives: To validate the accuracy of mitral annular displacement (MAD), assessed by Speckle Tracking Echocardiography (STE), as a surrogate for determination of left ventricular systolic function in comparison to 2-Dimensions Simpson method in patients with different heart diseases.Methods : This cross-sectional study included patients who referred to outpatient department of Ibn Albitar Center for Cardiac Surgery, Baghdad, Iraq, between October 2012 and April 2013. STE continuously tracked annular

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