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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
Sun Jun 30 2013
Journal Name
Al-kindy College Medical Journal
Clinical and Doppler Study of Restrictive Filling Pattern in Patients with Dilated Cardiomyopathy
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Background: Dilated cardiomyopathy (DCM) is a well-recognized cause of cardiovascular morbidity and mortality.Objectives: To evaluate the prognostic implications of the restrictive left ventricular filling pattern (RFP) in dilated cardiomyopathy.Methods: Patients with DCM admitted to Ibn AL-Bitar Hospital for Cardiac Surgery, Baghdad-Iraq, from May 2006 to August 2008, underwent a full clinical evaluation and Doppler echocardiography study. Patients were classified into three groups: Group I had persistent restrictive filling pattern; Group II had reversible restrictive filling pattern; and Group III had nonrestrictive filling pattern. Results: The current study was conducted on a total number of 80 patients with DCM, fifty (62.5 %) were

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Publication Date
Wed Oct 24 2018
Journal Name
Al-kindy College Medical Journal
Echocardiographic assessment of Left Ventricular Dyssynchrony in Hypertensive Patients with Normal Systolic Function
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Background: Normal Left Ventricular systolic function is present in nearly 50% of patients with congestive heart failure, the majority of such patients have systemic hypertension. Recent studies have demonstrated Left Ventricular dyssynchrony among patients with heart failure and normal systolic function. The co-existence between Left Ventricular dyssynchrony and hypertension with normal systolic function (with no clinical evidence of heart failure) is less well understood.

Objective:

To assess the Left Ventricular dyssynchrony among hypertensive patients with normal systolic function by using Tissue doppler imaging.To find out the associations between the LV dyssynchrony and other global

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Publication Date
Thu Jul 01 2010
Journal Name
Clinical And Experimental Rheumatology
RE-EVALUATION OF PATHERGY TEST IN IRAQI PATIENTS WITH BEHCET&#39;S DISEASE
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KE Sharquie, R Hayani, J Al-Rawi, A Noaimi, SH Radhy, CLINICAL AND EXPERIMENTAL RHEUMATOLOGY, 2010

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Publication Date
Tue Jan 02 2018
Journal Name
Journal Of Educational And Psychological Researches
The role of relaxation program for reducing anxiety of patients in dental clinic
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The role of relaxation program for reducing anxiety of patients in dental clinic  

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Publication Date
Tue Feb 26 2019
Journal Name
Journal Of Contemporary Medical Sciences
Demographic and clinical profiles of female patients diagnosed with breast cancer in Iraq
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Objective To highlight the main demographic characteristics and clinical profiles of female patients registered with breast cancer in Iraq; focusing on the impact of age.Methods This retrospective study enrolled 1172 female patients who were diagnosed with breast cancer at the Main Center for Early Detection of Breast Cancer/Medical City Teaching Hospital in Baghdad. Data were extracted from an established information system, developed by the principal author under supervision of WHO, that was based on valid clinical records of Iraqi patients affected by breast cancer. The recorded information regarding clinical examination comprised positive palpable lumps, bloody nipple discharge, skin changes, bilateral breast involvement, tumor

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Publication Date
Fri Dec 30 2011
Journal Name
Al-kindy College Medical Journal
Etiologies of chronic cough in adult patients: Is it hard to be diagnosed?
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Background: Chronic cough is often the key
symptom not only of chronic pulmonary diseases
but for other important extrapulmonary
pathologies, in particular upper airway and
gastrointestinal diseases.
Objective: This study was designed to
determine the etiology of chronic cough and the
usefulness of the available diagnostic tests in
reaching its causes.
Methods: One hundred patients presenting with
chronic cough at Baghdad Teaching Hospital
Outpatient Clinic were enrolled in this study. The
patients underwent a full clinical interview,
physical examination with indicated diagnostic
test(s) (such as chest x ray, bronchoscope, PFT,
GIT study, sinus X ray or CT).
Results: An etiology of chronic

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Publication Date
Fri Mar 19 2021
Journal Name
Annals Of The Romanian Society For Cell Biology
Immunological Value of Periostin, Amphiregulin, IL-33 and sST2 Markers in Rhinosinusitis Patients
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Background: Rhinosinusitis is an inflammatory disorder that refers to inflammation of the nose and paranasal sinuses. Recent studies show that serum IL-33, periostin, ARGE and sST2 had the role in the pathogenesis of chronic rhinosinusitis as an easy, non-invasive and readily available (biomarker) for diagnosis of chronic rhinosinusitis. We tested for correlations of IL-33, periostin, ARGE and sST2 between acute and chronic rhinosinusitis in compare to healthy people. This study aimed to Measure serum levels of periostin, IL-33, sST2, and ARGE biomarkers in patients ARS and CRS. Materials and Methods: We collected serum of 30 patients with acute rhinosinusitis, 30 with chronic rhinosinusitis, and 30 controls to examine serum levels of IL-3

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Publication Date
Fri Jan 01 2021
Journal Name
Eastern Journal Of Medicine
The role of Human Cytomegalovirus (HCMV) in Patients with Active Coeliac Disease (CD)
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Researchers have recently increased their focus on the link between autoimmune diseases and infections. Most of the recent research indicates that silent human cytomegalovirus (HCMV), may have diverse roles in the initiation, development, and exacerbation of autoimmune diseases, such as coeliac Disease (CD) and inflammatory bowel disease. The aim of this study is to evaluate the role of HCMV infection in Iraqi patients with CD. Serum samples were obtained from 60 patients with CD, and from 60 healthy subjects. Enzyme-linked immunosorbent assay was used to determine the Anti-Transglutaminase IgG/IgA, Anti-gliadin IgA/ IgG, as well as the HCMV IgM/ IgG levels in the serum samples. Significantly higher percentage of positivity for seru

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Publication Date
Sun Jun 07 2026
Journal Name
Journal Of Baghdad College Of Dentistry
Assessment of serum and salivary ceruloplasmin level in patients with oral lichen planus
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Background: Oxidative stress is a deleterious process that can be an important mediator of damage to cell structures and consequently various disease states. Exposure to free radicals from a variety of sources has led organisms to produce a series of defense mechanisms. The antioxidant ceruloplasmin is a copper-containing ferroxidase that can oxidize ferrous iron (Fe2+) to its nontoxic ferric (Fe3+) form. Ferrous iron (Fe2+) is extremely damaging because of its ability to generate toxic free radicals. Oral lichen planus (OLP) is a chronic inflammatory oral mucosal disease of unknown etiology. Previous studies reported that reactive oxygen species may be involved in the pathogenesis of lichen planus. The aim of this study was to estimate the

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Publication Date
Mon Jan 01 2018
Journal Name
Iosr Journal Of Pharmacy And Biological Sciences
Seroprevalence of Hepatitis B markers in Iraqi patients with chronic Hepatitis B virus
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To determine the seroprevalence of hepatitis B markers in chronic hepatitis B patients, 75 patients with chronic hepatitis B virus of ages (8-70) years have been investigated and compared with 50 apparently healthy individuals. All the studied groups were carried out to measure (HBsAg), (HBsAb), (HBeAg), (HBeAb), and (Total HBcAb) by Enzyme linked immunosorbent assay (ELISA) technique. The percentage distribution of HBsAg was (86.67%) and HBsAb was (1.33%) in sera of CHB patients and there were a highly significant differences (P<0.01) when compared between studied groups, while, the percentage distribution of HBeAg was (22.67%) in sera of CHB patients and the significant represent the difference in distribution of HBeAg as infection but no

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