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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 Jun 30 2011
Journal Name
Al-kindy College Medical Journal
The Role of Aspirin as Otoprotective Agent in Patients Receiving Amikacin Therapy
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Objective: To investigate and prove that aspirin
protects, or at least attenuates amikacin ototoxicity in
humans.
Method: This study was conducted in 60 patients that
completed all
requirements .The patients were divided into two
groups:
• Control group: receive placebo treatment.
• Drug–treated group: They receive aspirin
coated tablets (1.5gm/ day), 500mg 8 hourly.
Both groups had similar aspects regarding the gender,
age and weight. The duration of therapy was 7 days
and dosage of amikacin was 1gm/day (500mg 12
hourly).
Results: Comparison of Audiometry test in
Ear/Nose/Throat (E.N.T.) Department (Pure Tone
Audiometry) at 1000 Hertz (Hz), 2000 Hz, 4000 Hz,
and 8000 Hz showed sig

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Publication Date
Tue Dec 30 2008
Journal Name
Al-kindy College Medical Journal
Using of Laser Therapy in the Treatment of Patients With Plantar Fasciitis
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Background: planter fasciitis is a common condition
seen in adults and sport men, it is characterized by dull
pain in the heel, especially when getting up and
standing on the foot in the morning or after sitting for a
long time.
Recently low level laser therapy is used as a method of
treatment.
Objective: to evaluate the benefit of laser therapy in
treatment of planter fasciitis.
Methods: Out of twenty five patients with planter
fasciitis exposed to laser therapy. Laser used is (diode
type) given in two cessions per week for four weeks,
time for each cession is about (12 minutes).
Results: complete recovery seen in (32%) of patients,
moderate improvement in (16%), mild improvement in
(24%), no

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Publication Date
Wed Nov 07 2018
Journal Name
Iraqi National Journal Of Nursing Specialties
Assessment of Nurses’ Practices for Neurological Unconscious Patients in Intensive Care Units
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Objective(s): To assess nurses' practices for neurological unconscious patients in intensive care units.
Methodology: A descriptive study was conducted that included (50) nurse who are working in intensive care
units in hospitals and departments of the nervous system in (4) hospitals (neuroscience hospital, teaching
neurosurgical hospital, surgical specialist hospital, and sheck zaied hospital) in Baghdad city from March, 30th
,
2009 to July, 30th 2009 for the purpose of assessing their skills towards unconscious patients. A purposive "nonprobability
sample" was selected that consisted of (50) nurse who are working in intensive care units. A
questionnaire format and observational checklist were used which consist of

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Publication Date
Mon Feb 18 2019
Journal Name
Iraqi Journal Of Physics
The evaluation of left ventricle stiffness index in patients suffering from hypertension
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Many diseases can produce cardiac overload, of these disease hypertension, valve disease congenital anomaly in addition to many other disease. One of the most common diseases causing left ventricle overload is hypertension. A long term hypertension can cause myocardium hypertrophy leading to changes in the cardiac contractility and reduced efficiency. The investigations were carried out using conventional echocardiography techniques in addition to the tissue Doppler imaging (TDI) from which many noninvasive measurements can be readily obtained. The study has involved the effect of hypertension on the myocardium stiffness index through the measurement of early diastolic filling (E) and the early velocity of lateral mitral annulus (Ea

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Publication Date
Mon Jul 01 2024
Journal Name
Indian Journal Of Clinical Biochemistry
Evaluation of Bone Turnover Markers in Patients with Acute and Chronic Leukemia
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Publication Date
Sun Dec 07 2014
Journal Name
Baghdad Science Journal
Studying Association between Thyroid Disorders and Helicobacter pylori infection in Iraqi Patients
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This study was aimed to investigate the association between thyroid disorder and Helicobacter pylori infection in 122 patients (100 females and 22 males )and for comparison, 60 healthy individuals (31females and 29 males),who had no thyroid disorder, were also included in the study. Blood samples were collected from both patients and the healthier individuals. Enzyme Linked Fluorescent Assay (ELFA) technique through using Vitek Immuno Diagnostic Assay System (VIDAS) was applied to measure levels of the thyroid hormones (tri-iodothyronine T3, tetra-iodothyroxine T4) and thyroid stimulating hormone (TSH). From the results obtained, patients were classified into three groups: 40 were

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Publication Date
Mon Jul 01 2024
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Study of Adhesion Molecules in Diabetes Mellitus Type2 Iraqi Patients with Dyslipidemia
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Background: Cell adhesion molecules are protein entities that are located on the cell surface. The vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) expression is related to type 2 diabetes mellitus (T2DM) with dyslipidemia. Objectives: To determine the levels of VCAM-1 and ICAM-1 in T2DM patients with dyslipidemia and to explore the relationship between VCAM-1 and ICAM-1 and the development of dyslipidemia in T2DM patients. Patients and methods: The study included 150 individuals with an age range of (35-55) years. Patients with diabetes for more than 5 years were excluded. Fifty healthy individuals constituted Group 1 (G1), fifty patients with T2DM constituted Group 2 (G2), and fifty T2DM p

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Publication Date
Mon Sep 12 2022
Journal Name
Biomedicine
An assessment of serum interleukin - 39 in rheumatoid arthritis patients from Iraq
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Introduction and Aim: The pro-inflammatory cytokine IL-39, a member of the IL-12 family plays a key role in the inflammatory response by modulating immune cell activity and inflammation. A literature search shows no study undertaken for the effect of IL-39's on arthritis so far. Hence, the purpose of this study was to investigate the role of IL-39 in rheumatoid arthritis. Materials and Methods: This study involved 80 patients with rheumatoid arthritis registered at the Rheumatology Clinic at Baghdad teaching hospital. The patients were divided into three groups based on treatments received. Group 1 included patients who were not on any treatment for arthritis, Group 2 with patients on hydroxychloroquine and or prednisone treatment,

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Publication Date
Sun Jun 03 2012
Journal Name
Baghdad Science Journal
Staphylococcal infections among leukemic patients
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Staphylococcus are cause hospital community acquired infection and they are an important cause of health –care associated infection.The Coagulase positive Staphylococcus are Staphylococcus aureus which can implicated in toxic shock syndrome. Methicillin and Vancomycin Staphylococcus aureus resistant (MRSA, VRSA) become major cause of hospital- acquired infection and community acquired infection.Coagulase negative staphylococcus emerged as major cause of infection in immunocompromised patients.The main objective of this study was to evaluate the distribution of Staphylococci among leukemic patients since it is well known that leukemic patients are prone to be infected easily due to their immunosuppressed status.This study was undertaken b

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Publication Date
Mon Dec 01 2025
Journal Name
Journal Of Physical Education
The reality of the physical education lesson in the schools of Baghdad governorate from the point of view of the applied students
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