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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
Wed Oct 17 2018
Journal Name
Journal Of Economics And Administrative Sciences
Comparison of Two of (Turnbull) and (Generalization Turnbulls)non-parametric methods in estimating conditional survival function (applied study on breast cancer patients)
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   This research includes the application of non-parametric methods in estimating the conditional survival function represented in a method (Turnbull) and (Generalization Turnbull's) using data for Interval censored of breast cancer and two types of treatment, Chemotherapy and radiation therapy and age is continuous variable, The algorithm of estimators was applied through using (MATLAB) and then the use average Mean Square Error (MSE) as amusement  to the estimates and the results showed (generalization of Turnbull's) In estimating the conditional survival function and for both treatments ,The estimated survival of the patients does not show very large differences

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Publication Date
Thu Jul 02 2020
Journal Name
International Journal Of Pharmaceutical Research
The Correlation of TGF-ß Level and GARP Gene Expression in Iraqi Patients with Rheumatoid Arthritis Treated By Biological and Chemo-Therapy
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Publication Date
Tue Jan 01 2019
Journal Name
Biochemical & Cellular Archives
Assessment of uric acid in patients of end-stage renal disease with hypertension and diabetic nephropathy and the risk of cardiovascular diseases
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The relationship of hyperuricemia to kidney disease, diabetes, hypertension and the risk of cardiovascular diseases remain controversial. The aim of this study is to evaluate the use of uric acid (UA) levels to find the higher risk of cardiovascular disease (CVD) in patients with end stage renal disease that have diabetic nephropathy (DN), nephropathy with hypertension (NH) and patients with both diabetic nephropathy with hypertension (DNH). This study deals with 115 patients with end-stage renal disease under hemodialysis sub-grouped into 35 patients with (DN), 40 patients with (NH), and 40 patients with (DNH). Some biochemical parameters were determined in the serum of all participants such as HbA1c, fasting blood glucose (FBG), UA, urea,

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Publication Date
Tue Aug 30 2022
Journal Name
Research Journal Of Pharmacy And Technology
Correlation of Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers with serum GDF-15 in a group of hypertensive Iraqi patients
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The Growth Differentiation Factor -15 (GDF-15) is a member of the transforming growth factor β superfamily. İt represents an example of the stress response cytokines. It's mostly found in cardiac myocytes, adipocytes, macrophages, endothelial cells, and vascular endothelial cells, whether they're generated normally or not. GDF-15 levels have increased and are associated with cardiovascular risk. Aim of the study: To investigate the correlation between angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) with the level of plasma GDF-15 in a group of hypertensive patients. Materials and methods: A case-control study involved 90 individuals, 60 hypertensive patients (36 on ACE inhibitors and 24 on ARBs)

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Publication Date
Tue Dec 26 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
A Comparative Study of Blood Levels of Manganese, Some Macroelements and Heavy Metals in Obese and Non-Obese Polycystic Ovary Syndrome Patients
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Polycystic ovary syndrome (PCOS) is a prevalent condition in women of reproductive age. It is characterized by androgen excess and chronic anovulation. Some trace elements, macroelements, and heavy metals have been linked to pathophysiological mechanisms of PCOS .

To study the alterations in the serum levels of the trace element manganese (Mn), some macroelements, magnesium(Mg) and calcium (Ca), and the heavy metals cadmium (Cd) and lead (Pb), in obese and non-obese PCOS patients; and the association of these alterations with some of the hormonal changes occurring in PCOS.

The study was carried out at Kamal Al-Samarrai Hospital (Center for Infertility treatment and in vitro Fertilization "IVF") Baghdad- Iraq. Eig

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Publication Date
Tue Feb 25 2020
Journal Name
Open Access Macedonian Journal Of Medical Sciences
Evaluation of Hepatocyte Growth Factor in Iraqi Patients with Acute Myeloid Leukemia: Its Correlation with Clinical Parameters and Response to Induction Therapy
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BACKGROUND: Hepatocyte growth factor (HGF) is a proangiogenic factor that exerts different effects over stem cell survival growth, apoptosis, and adhesion. Its impact on leukemogenesis has been established by many studies. AIM: This study aimed to determine the effect of plasma HGF activity on acute myeloid leukemia (AML) patients at presentation and after remission. PATIENTS AND METHODS: This was a cross-sectional prospective study of 30 newly-diagnosed, adult, and AML patients. All patients received the 7+3 treatment protocol. Patients’ clinical data were taken at presentation, and patients were followed up for 6 months to evaluate the clinical status. Plasma HGF levels were estimated by ELISA based methods in the pa

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Publication Date
Wed Jul 01 2020
Journal Name
Indian Journal Of Forensic Medicine & Toxicology
Assessment of undergraduate critical care nursing students ‘ knowledge and attitudes toward caring of dying patients in colleges of nursing at Baghdad university
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Publication Date
Wed Sep 27 2023
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Assessment of Serum Levels of Advanced Oxidation Protein Products in Type 2 Diabetic Patients with and without Retinopathy Taking Different Antidiabetic Treatments
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The goal of this study was to investigate the protein peroxidation role by measuring serum levels of advanced oxidation protein products (AOPP) in type 2 diabetic patients with or without retinopathy and comparing them to controls to see if circulating AOPP levels can be used as a detection biomarker for DR. And see which of the two widely used antidiabetic treatment groups had the most impact on this oxidative stress marker. The groups were divided into two subgroups: 1) 70 type 2 diabetic patients (36 male, 34 female), 35 with diabetic retinopathy (DR) and 35 with no evidence of DR, and 2) non-diabetic controls (11 male, 9 female) were chosen from Ibn AL-Haitham Hospital for Ophthalmology and a Specialized Center for Endocrinology and Dia

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Publication Date
Tue Dec 02 2025
Journal Name
Journal Of Baghdad College Of Dentistry
Craniometric asymmetry assessment in class I and class II skeletal relationship patients using helical computed tomography sample aged between 18-35 years
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Background: Asymmetry assessment is an important component of orthodontic diagnosis and treatment planning. Several studies attempted to find the relationship between craniometric asymmetry and skeletal jaws relationship and many authors found some extent of asymmetry in individuals with normal jaws relationship. The use of Computed tomography (CT) allows for the assessment of asymmetry on a dimensionally accurate volumetric image, aim of the study is to determine if there are differences in craniometric asymmetry between patient with skeletal class I and patients with skeletal class II relationship using Helical CT scan. Materials and Methods: Ninety individuals with clinically symmetrical faces were imaged with Helical CT scan, and aging

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Publication Date
Mon Mar 13 2017
Journal Name
Journal Of Baghdad College Of Dentistry
Gingival health condition and salivary physical properties among a group of patients with intermaxillary fixation in tow times intervals (Follow up study)
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ABSTRACT Background: One of the methods used in the treatment of maxillofacial fracture is intermaxillary fixation(IMF), the most common type is the Erich arch bar with interdental wiring. This study was conducted to investigate the impact of intermaxillary fixation on gingival health condition among a group of patients with facial fracture in relation to salivary physical properties. Materials and methods: Thirty patients with an age range of (17-37) years old with facial fractures and indicated for IMF. Plaque index and gingival index (Loe, 1967) were used to assess both of them before application and after removal of IMF. Unstimulated saliva sample collection was carried out under standardized conditions according to Navazesh and Kum

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