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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 Aug 23 2022
Journal Name
International Journal Of Health Sciences
Association between periostin and bone minerals in osteoporosis and osteopenia Iraqi patients
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Background: osteoporosis is characterized by a reduction in bone mineral density, skeletal microstructure breakdown, increased bone fragility, and fracture susceptibility. Osteopenia is the preceding step to osteoporosis because it causes a decrease in bone mass, osteoporosis reduces a person's quality of life. Periostin (encoded by Postn), its name is derived from the fact that it was first detected in periosteal osteocytes and osteoblasts. Periostin deficiency has been linked to osteoporosis and weak bones. Study objectives: The purpose of this study was to determine periostin levels in serum of Iraqi patients with osteoporosis and osteopenia, and it is also possible to consider periostin as a diagnostic factor to follow the progression o

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Publication Date
Tue Jun 30 2015
Journal Name
Al-kindy College Medical Journal
Extrapituitary prolactin –1149 G/T promoter polymorphism in some rheumatoid arthritis patients
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Background: Prolactin is a hormone, as well as a cytokine which is synthesized and secreted from the anterior pituitary gland and various extra pituitary sites including immune cells under control of a superdistal promoter that contains a single nucleotide polymorphism -1149 G/T. Rheumatoid Arthritis has been associated with increased serum prolactin levels.Objectives: To investigate the association of the extra pituitary -1149 G/T promoter polymorphism among Iraqi rheumatoid arthritis patients and prolactin levels.Methods: We tested 73 patients with rheumatoid arthritis and 40 healthy individuals. The DNA samples were genotyped using the Polymerase Chain Reaction-Restriction fragment Length Polymorphism method and the levels of prolacti

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Publication Date
Tue Mar 28 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Therapeutic Response of Serum Lipids to Atorvastatin in Type II Diabetic Patients
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Lipid disorders and cardiovascular disease (CVD) risk are known to be increased in patients with diabetes mellitus. The effects of statins on serum lipid levels are well known; however, previous studies did not compare the effects of statins on serum lipid levels in diabetic patients with non-diabetic patients. To investigate the effects of Atorvastatin on serum lipid profiles in hyperlipidemic patients with type 2 diabetes mellitus in comparison with hyperlipidemic patients without diabetes.This study was conducted on 33 type 2 diabetic patients & 34 non-diabetic patients; their age range was 40-80 years, all of them were hyperlipidemic, who had been administered 10, 20, & 40 mg daily of Atorvastatin and completed a 6-month foll

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Publication Date
Fri Jul 22 2022
Journal Name
Biochemical And Cellular Archive
HEPATITIS B VIRUS GENOTYPES IN IRAQI PATIENTS WITH CHRONIC HEPATITIS B INFECTION
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Hepatitis B virus (HBV) infection is a serious disease of the liver and signifies a major worldwide health concern. HBV Genotyping is vital for further epidemiological study, predicting the disease outcome and response to treatment. The current study aimed to determine hepatitis B virus genotypes in patients with chronic hepatitis B, and to validate possible associations with the baseline characteristics of the disease. A total of 90 patients with chronic hepatitis B infection were enrolled in this study. Liver function tests, hepatitis B virus markers and DNA viral load were done using routine standardized procedures. HBV genotyping was performed using real time PCR. Genotype D was the most predominant in 64 (71.1%) of samples, while

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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
Mon Oct 19 2026
Journal Name
Journal Of Baghdad College Of Dentistry
The Prevalence of Oral Protozoa Trichomona Stenax in some Patients with Gingivitis
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Background:As arelationshipbetween gingivitis disease and the presence of the oral protozoa Trichomonastenax has been represented byconsiderable differences among various study population.The purpose of present study is determining the prevalence of T.tenax in patients with gingivitis and healthy subjects. Subjects,Materials and Methods:The presence of the parasite has been diagnosed with 58 patients withgingivitisand 58 healthy persons during the period of the study(April and May 2015) by taken two swabs for each one,microscopic examination was done using saline wet mount method and stained method. Age, sex and brushing teeth habit were in a count. Statistical analysis was done by SPSS program. Results:Gingivitis disease was observed in 5

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Publication Date
Fri May 25 2018
Journal Name
Journal Of Physics: Conference Series
Partial purification of Leucine aminopeptidase (LAP) in Acromegalic Sample of Iraqi Patients
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Publication Date
Tue May 01 2007
Journal Name
Saudi Medical Journal
Invasive squamous cell carcinoma of the eyes in patients with epidermodysplasia verruciformis.
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KE Sharquie, SA Al-Meshhadani, AA Al-Nuaimy, Saudi medical journal, 2007 - Cited by 9

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Publication Date
Wed Apr 02 2014
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 (E

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Publication Date
Thu Nov 21 2019
Journal Name
Al-kindy College Medical Journal
Magnetic Resonance Venography Findings In A Group Of Patients With Multiple Sclerosis
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Background: Multiple sclerosis is a chronic heterogeneous demyelinating axonal and inflammatory disease involving the Central Nervous System [CNS] white matter with a possibility of gray matter involvement in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of parts of the nervous system to communicate, resulting in a wide range of signs and symptoms. Cerebral venous insufficiency theory was raised as a possible etiology for the disease at 2008 by Zamboni an Italian cardiothoracic surgeon. This theory was defeated by Multiple Sclerosis[ MS] researchers and scientists who thought that the disease is an autoimmune rather than vascular.

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