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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
Sat Apr 29 2023
Journal Name
Research Journal Of Pharmacy And Technology
Assessment of Serum Neopterin Levels in patients hospitalized with severe COVID-19
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Background: COVID-19 has caused a considerable number of hospital admissions in China since December 2019. Many COVID-19 patients experience signs of acute respiratory distress syndrome, and some are even in danger of dying. Objective: to measure the serum levels of D-dimer, Neutrophil-Lymphocyte count ratio (NLR), and neopterin in patients hospitalized with severe COVID-19 in Baghdad, Iraq. And to determine the cut-off values (critical values) of these markers for the distinction between the severe patients diagnosed with COVID‐19 and the controls. Materials and methods: In this case-control study, we collect blood from 89 subjects, 45 were severe patients hospitalized in many Baghdad medical centers who were diagnosed with COVID

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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
Sat Apr 30 2022
Journal Name
Pakistan Journal Of Medical And Health Sciences
Role of Progranulin and its Implication in Knee Osteoarthritis among Iraqi Patients
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Background: Osteoarthritis is a complicated, chronic disorder of cartilage and bone, associated with homeostasis of bio-elements. The current study aims to assess the role of serum progranulin levels among Iraqi patients with knee osteoarthritis. Patients and Methods: The study encompassed 50 patients aged 52.50 ± 3.12 years (25 males and 25 females), admitted to the at the Baghdad Medical City through the period from November 2021 to March 2022. All individuals were identified by physicians in a Rheumatology and Rehabilitation Outpatient Clinic and the clinical data was collected along with the assess¬ment of biochemical parameters. Fasting serum glucose, lipid profile, calcium, magnesium, alkaline phosphatase, vitamin D3, and p

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Publication Date
Sun Oct 18 2026
Journal Name
Journal Of Baghdad College Of Dentistry
Assessment of serum and salivary malondialdehyde in patients with oral lichen planus
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Background: The aim of this study was to evaluate the expression of fibroblast growth factor-2 and Heparanase in salivary pleomorphic adenoma, and to correlate the two studied markers with each other and with clinicopathological parameters including: age, sex, tumor site and histopathological presentation. Methods: Sections of twenty five formalin-fixed paraffin embedded tissue blocks specimens of salivary pleomorphic adenoma were immunostained using monoclonal antibodies (Fibroblast growth factor-2 and Heparanase) to assess their expression in this tumor. Results: The expression of fibroblast growth factor-2 and Heparanase were positive in all pleomorphic adenoma cases (100%). The positive expression of fibroblast growth factor-2 was signi

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Publication Date
Tue Jan 01 2019
Journal Name
Indian Journal Of Forensic Medicine &amp; Toxicology
Immunohistochemical Assessment of SOX2 Expression in Iraqi Patients with Gastric Carcinoma (GC)
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Objective: To evaluate whether the SOX2 protein could be used as a predictor in patients with GC and to assessment the correlation between the IHC expression of the SOX2 protein and the various clinic pathological Parameters as age, sex, histopathological subtypes, grade and stage of the tumor by immune-histochemical Technique. This is a retrospective study conducted on 60 randomly selected patients (30) normal versus (30) GC, at the pathology department of the Gastroenterology and Hepatology Teaching Hospital & some private hospitals. It were collected and diagnosed during the period between from 2014 to 2018. From each block were stained with H&E and IHC stained for SOX2. The Statistical analysis was done using SPSS system, and the differ

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Publication Date
Fri Oct 01 2010
Journal Name
Saudi Pharmaceutical Journal
Comparative clinical evaluation of ketotifen and montelukast sodium in asthmatic Iraqi patients
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Publication Date
Sun Dec 05 2010
Journal Name
Baghdad Science Journal
Measuring the concentration of some hormones in patients sera of polycystic ovaries
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Extensive evaluation of 76 women with polycystic ovary syndrome compared with 25 fertile women as control group was achieved by routine investigations and hormonal study of each female which were done in one period during the menstrual cycle. Then the women with PCOS have been divided into 2 groups according to their menstrual cycle (irregular menstrual cycle) during assessing their hormonal profiles as follow:- 1- (54) Patients with oligomenorrhea. 2- (22) Patients with menorrhea. This study shows that the women with PCOs have different clinical features taken from a history of disease of all of the women. Those features were distributed as follow: 57.92% of them suffer from hirsutism. 19.24% suffer from irregular menstr

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Publication Date
Tue Jan 12 2016
Journal Name
Al-mustansiriyah Journal Of Science
Studying of Kidney , Liver Functions and Some Blood Ions In Toxoplasmosis Patients
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The present study was conducted to investigate the effects of toxoplasmosis on liver, kidney and some blood ions such as calcium, potassium & sodium. A total of 100 blood samples were obtained from pregnant women in several health centers in Baghdad city. which consist of 70 seropositive & 30 seronegative/control group, aged between 20 & 47 years old from September 2013 till September 2014. All of these cases were tested to specific antibody to Toxoplasma gondii by using a latex agglutination test and IgM & IgG antibodies using the ELISA technique. The serum samples were examined for liver function (serum aspartate aminotransferase [AST/GOT], serum alanine aminotransferase [ALT/GPT] and serum alkaline phosphatase [ALP]; kidney function (ser

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Publication Date
Thu Jun 30 2011
Journal Name
Al-kindy College Medical Journal
Results of Kidney Biopsies among Adult Iraqi Patients in a Single Center
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Background: Patients requiring renal biopsies have various glomerular diseases according to their demographic characteristics.
Objective: To study types of glomerular disease among adult Iraqi patients in a single center in Baghdad/Iraq
Material and Methods: A total of 120 native kidney biopsies were studied. All biopsies were adequate and were processed for Light Microscopy.
The age range of the study patients was 17-67 years, with a mean of 38.5 years. The mean follow up period was 28 weeks (4-52 weeks)
Indication for biopsy included: Nephrotic syndrome (N=72; 60%), Asymptomatic proteinuria (N=21; 17.5%), acute nephritic presentation (N=17; 14.16%), asymptomatic haematuria (N=10; 8.33%).
Results: Primary glomerulonephrit

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Publication Date
Thu Apr 18 2019
Journal Name
Al-kindy College Medical Journal
Correlating CT findings of stroke with hyperglycemia in acute ischemic stroke patients
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Background: Studies show that diabetic patients have a higher incidence of ischemic stroke than non-diabetic patients. In the Framingham study the incidence of thrombotic stroke was 25 times higher in diabetic men and 36 times higher in diabetic women than in those without diabetes

Objectives: aim of this study to analyze topography in diabetic patients.

Type of study:  Cross sectional study.

Methods: 48 patients with acute stroke were classified into 4 groups: euglycemic, stress hyperglycemia, newly diagnosed diabetics, and known diabetics.

Results:no significant differences were found in the type, site or size of st

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