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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
Tue Dec 30 2008
Journal Name
Al-kindy College Medical Journal
Exfoliative Cytological Changes in Peritoneal Fluid from Patients on Peritoneal Dialysis
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Background: Ambulatory peritoneal dialysis
introduced by Popvich et al (13) in 1978 , consists of a
four to five hours lavage of peritoneal cavity with 2000
ml of glucose solution .It remains a useful method for
treating patients with end stage renal failure till renal
transplantation becomes possible.
Objectives: The aim of the study is to evaluate the
value of cytological changes of mesothelial cells in
dialysate patients.
Methods: Within one year period, 32 cytological
peritoneal fluid samples were collected from patients
with end stage renal failure regardless of the underlying
causes, admitted to the dialyzing unit in Kadimya
Teaching Hospital. Smears were prepared and fixed in
95 % ethyl al

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Publication Date
Wed Aug 30 2023
Journal Name
Baghdad Science Journal
Biochemical Action of Vaccines in Iraqi Patients with COVID-19 Infection
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      The aim of the present study is to compare the biochemical action of the three vaccines taken in Iraq: Pfizer Biontech, AstraZeneca Oxford and Sinopharm based on biochemical parameters. Seventy COVID-19 Iraqi patients ( males and females ) were participated in the present study and classified into 7 groups : Gc :  COVID-19 patients ( without vaccine ) , Gp1: COVID-19 patients took one dose of Pfizer Biontech, Gp2 : COVID-19 patients took two doses of Pfizer Biontech, Ga1 : patients took one dose of AstraZeneca Oxford vaccine , Ga2: patients took two doses of AstraZeneca Oxford vaccine , Gs1 : patients took one dose of Sinopharm vaccine and Gs2:

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Publication Date
Sun Sep 07 2014
Journal Name
Baghdad Science Journal
Correlation between malondialdehyde and metanephrine in patients with acute lymphoblastic leukemia
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Acute lymphoblastic leukemia (ALL) is one of the most common diseases , so in this study the serum level of malondialdehyde and its relationship with metanephrine was investigated in acute lymphoblastic leukemia patients over one month of treatment. Some biochemical parameters (serum glucose , total serum protein , malondialdehyde ,vitamin C, and metanephrine) changed as well as white blood cell count and blood hemoglobinlevelswere analyzed in sixty patients diagnosed with acute lymphoblastic leukemia over one month of treatment compared to healthy control group.Statistically significant increases (p<0.01) in white blood cell (WBC) count, mean concentrations of malondialdehyde (MDA) (p< 0.05) and metanephrine (p< 0.001) were observed in

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Publication Date
Wed Sep 14 2016
Journal Name
Journal Of Baghdad College Of Dentistry
Salivary Immunoglobulin A Assessment in Lymphoma Patients before and after Chemotherapy
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Background: Lymphomas are group of diseases caused by malignant lymphocytes that accumulate in lymph nodes and caused the characteristics lymphadenopathy. Occasionally, they may spill over into blood or infiltrate organs outside the lymphoid tissue. The major subdivision of lymphomas is into Hodgkin lymphoma and non–Hodgkin lymphoma and this is based on the histologic presence of Reed-Sternberg cells in Hodgkin lymphoma. Salivary immunoglobulin A is the prominent immunoglobulin and is considered to be the main specific defense mechanism in oral cavity. The aim of this study was to determine the level of salivary immunoglobulin A in lymphoma patients before and after chemotherapy treatment. Subjects, materials and methods: The study i

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Publication Date
Thu Nov 01 2012
Journal Name
The Iraqi Postgraduate Medical Journal
Isolation and identification of Malassezia species in patients with pityriasis versicolor
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JM Karhoot, AA Noaimi, WF Ahmad, The Iraqi Postgraduate Medical Journal, 2012 - Cited by 7

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Publication Date
Fri Dec 01 2017
Journal Name
Journal Of Global Pharma Technology
Influence of immune engines in iraqi patients with acute myeloid leukemia
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Acute myeloid leukemia (AML) is heterogeneous disorders originated from the abnormalities in the proliferation and maturation of myeloid progenitors in bone morrow. There is a clinical correlation between immunity engines and disease progression, but this relationship is not completely clear yet. This study was designed to assess the full immune response in Iraqi patients diagnosed with AML. Patients and healthy volunteers were divided into three groups: newly diagnosed untreated, under chemotherapy treatment patients and control group. A significant reduction were seen in C4 and IFN-γ levels in both untreated and treated groups with no significant difference between untreated and treated groups. On the other hand, IL-2 and IL-8 levels inc

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Publication Date
Sat Oct 01 2022
Journal Name
The Egyptian Rheumatologist
Diagnostic potential of interleukin-40 (IL-40) in rheumatoid arthritis patients
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Publication Date
Sun Mar 01 2015
Journal Name
Baghdad Science Journal
Assessment of Serum Prolactin Level in Patients Women with Rheumatoid Arthritis
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The prolactin hormone played role in the many autoimmune disorders. To determine the importance of high levels of prolactin in triggering rheumatoid arthritis, thirty patient's women with hyperprolactinemia aged (20-45) years old have been investigated and compared with twenty five healthy individuals. All the studied groups were carried out to measure the concentration of citrulinated peptide(CCP) by enzyme linked immunosorbent assay( ELISA), antikeratin antibodies (AKA)and antinuclear antibodies(ANA) by indirect fluorescent assay IFAT. There was a significant elevation of CCP concentration compared with control groups (P< 0.05). The percentage of antikeratin antibodies and antinuclear antibodies was (20%, 10%) respectively, and

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Publication Date
Mon Mar 06 2023
Journal Name
Rheumatology (bulgaria)
Tenascin-C and Interleukin-17 Up-regulation in Axial Spondyloarthritis Patients
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Background: Axial spondyloarthritis (axSpA) is an inflammatory, systemic rheumatic condition that mostly affects the axial skeleton. Tenascin-C (TN-C) is a hexameric glycoprotein of considerable size, upregulated in many inflammatory conditions, while Interleukin-17 (IL-17) a cytokine that plays an important role in SpA symptoms. Objective: to investigate the upregulation between the serum levels of TN-C and IL-17 in Iraqi axSpA patients and the disease characteristics. Patients and Methods: Seventy-four axSpA patients and 28 matched controls were studied. Fifty-four patients received a tumor necrosis factor inhibitor (TNFi) and 20 did not. Serum TN-C and IL-17 concentrations were determined using the ELISA technique. The Bath Ankyl

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Publication Date
Sat Oct 01 2022
Journal Name
Baghdad Science Journal
The Immunohistochemically Estimation of CD63 in Iraqi Patients with Gastric Cancer
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CD63 is -one of the tetraspanin family proteins, which are regarded as: hallmark exosomal markers because it is absent from other types of vesicles. It is expressed in the cell membrane of cancer cells, and cytoplasm of stromal cells. Objective: To assess CD63 expression in gastric cancer (GC) patients, and detected if it could be used as a predictive marker. Furthermore, the current study aimed to find the correlation between CD63 expression and clinicopathological parameters as: gender, age, invasion depth, histopathological type, involvement of lymph nodes, grade and stages of GC (TNM). The current study is a retrospective study in the period time from (2018 to-2020); 50 randomly patients formalin-fixed paraffin embedded blocks (FFPE)

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