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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 Jun 20 2023
Journal Name
Baghdad Science Journal
Estimation levels of CTHRC1and some cytokines in Iraqi patients with Rheumatoid Arthritis
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Collagen triple helix repeat containing-1 (CTHRC1) is an essential marker for Rheumatoid Arthritis (RA), but its relationship with pro-inflammatory, anti-inflammatory, and inflammatory markers has been scantily covered in extant literature. To evaluate the level of CTHRC1 protein in the sera of 100 RA patients and 25 control and compare levels of tumour necrosis factor alpha (TNF-α), interleukin 10 (IL-10), RA disease activity (DAS28), and inflammatory factors. Higher significant serum levels of CTHRC1 (29.367 ng/ml), TNF-α (63.488 pg/ml), and IL-10 (67.1 pg/ml) were found in patient sera as compared to that in control sera (CTHRC1 = 15.732 ng/ml, TNF-α = 33.788 pg/ml, and IL-10 = 25.122 pg/ml). There was no significant correlati

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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
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 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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Publication Date
Fri Jan 19 2024
Journal Name
Baghdad Science Journal
GRHPR gene variations in Iraqi patients infected with calcium oxalate kidney stones
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      The alterations in glyoxylate reductase and hydroxy-pyruvate reductase concentrations in the sera and the genetic alterations associated with calcium oxalate kidney stones in Iraqi patients were not studied previously so this study aimed to focus on these points. This study included 80 subjects; they were 50 patients with calcium oxalate stones compared to 30 apparently healthy controls. Biochemical investigations for kidney functions (creatinine, urea, and uric acid), were performed on the sera of both groups. Also, complete blood count, random blood sugar, and blood group tests. Furthermore, urine had been collected for General Urine Examination to visualize oxalate crystals in the urine of the patient. Also, the GRHPR

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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
Thu Apr 30 2026
Journal Name
Iraqi Journal Of Science
The Polymorphism of OCRL Gene in Kidney Stones and Kidney Failure Patients
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Kidney disease is a kidney injury or disease that affects many people globally. The study aims to evaluate the effect of Phosphatidyl Inositol (4,5) Bisphosphate, 5-Phosphatase (PIP2) enzyme on calcium (Ca2+) levels and its relationship to oculocerebrorenal gene variations in kidney stone and kidney failure patients. The enzyme-produced amount was measured by enzyme-linked immunosorbent assay (ELISA). Genetic variations were studied through the polymerase chain reaction (PCR) technique, followed by the sequencing of fragments of the exons (9, 13, 15). Blood samples were collected from eighty patients (40 with kidney stones and 40 with kidney failure), and 40 were healthy individuals. Results showed a significant difference between t

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Publication Date
Sun Apr 02 2017
Journal Name
Journal Of Educational And Psychological Researches
Article Sources mutual complaint among the Directorates of Education staff and directors of Secondary schools in the province of Baghdad in light of some variables
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A field study aimed at identifying the sources of mutual complaints among the Directorates of Education staff of their departments and management and run it in their daily dealings with principals in the province of Baghdad, and adopt approach. It was determined the research consists of (2357) male and female employees and 305 randomly stratified simple by the rate of (7%) from the research community as the number of sample reached (167) male and female employees, and selected sample was randomly stratified simple by the rate of (39.67%) of the research community, as the number of sample was (121) principals. It was constructed two questionnaires, the first included (28) items and the second contained (28) items. And the two researchers

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Publication Date
Tue Dec 01 2015
Journal Name
Journal Of Economics And Administrative Sciences
(Determine the Impact of Public Relations Ethics in Strategic Decisions) Descriptive Analytical Study of a Sample of Administrative Leadership in the Ministry of Higher Education
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Role of public relations (PR) and from one community to another, depending on the different cultures of these societies in General, and different ethical values established by their practitioners in these communities organizations  , public relations in developed societies, and in  some developing countries have taken great strides to contribute to the strategic planning and decision-making, in the framework of their commitment to the values and ethical standards for practitioners, In contrast, we find that applied in Iraq still skips phase coordinate with different communication means with the aim of advertising and publicity for the organization. As a result of the limited recognition of the strategic and vital 

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Publication Date
Tue Feb 05 2019
Journal Name
Journal Of The College Of Education For Women
The effect of teaching using the six thinking hats on academic achievement for students in the second grade average in the subject of family education
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Research problem:
Problem of current research can determine the dimensions to answer the following question: The effect of teaching using the six thinking hats on academic achievement for students in the second grade average in the subject of Family Education. The importance of research: research is gaining importance in terms of:
1. That this research is the first of its kind in the researcher's knowledge _ which deals with the teaching of Family Education by using the six hats, the researcher hopes to fill a gap in the educational field and serve in other studies serve the materials home economics. 2. Keep pace with the new field of modern education and strategies. 3. Highlight on the educational strategy in the field of creative

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