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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 Feb 04 2025
Journal Name
Journal Of Communicable Diseases
Correlation between MicroRNA-155 Expression and Viral Load in Severe COVID-19 Patients
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Background: The SARS-CoV-2 virus causes COVID-19, a respiratory syndrome. It causes inflammation and damages several organs in the body. miRNAs play a role in regulating the infection resulting from SARS-CoV-2. MicroRNA-155, a kind of microRNA linked to viral defences, can affect the immune responses during COVID-19. Objectives: Examination of the involvement of microRNA-155 in the development and severity of COVID-19, as well as finding the correlation between microRNA-155 and viral load (copies/mL) in severe cases of the disease. Materials and Method: A case-control research study was performed between October 2022 and June 2023. It included a cohort of 120 hospitalised individuals with severe cases of COVID-19, together with 115 individu

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Publication Date
Fri Sep 27 2019
Journal Name
Journal Of Baghdad College Of Dentistry
Clinical Assessment and Cytomorphometric Analysis of Buccal Mucosal Cells in Behçet’s Disease Patients
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Background: Behçet’s disease (BD) is a disorder of systemic inflammatory condition. Its important features are represented by recurrent oral, genital ulcerations and eye lesions. Aims. The purpose of the current study was to evaluate and compare cytological changes using morphometric analysis of the exfoliated buccal mucosal cells in Behçet’s disease patients and healthy controls, and to evaluate the clinical characteristics of Behçet’s disease. Methods. Twenty five Behçet’s disease patients have been compared to 25 healthy volunteers as a control group. Papanicolaou stain was used for staining the smears taken from buccal epithelial cells to be analyzed cytomorphometrically. The image analysis software has been used to

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Publication Date
Sun Oct 01 2023
Journal Name
Baghdad Science Journal
Estimation of Apelin Levels in Iraqi Patients with Type II Diabetic Peripheral Neuropathy
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Diabetes mellitus type 2 (T2DM) is a chronic and progressive condition, which affects people all around the world. The risk of complications increases with age if the disease is not managed properly. Diabetic neuropathy is caused by excessive blood glucose and lipid levels, resulting in nerve damage. Apelin is a peptide hormone that is found in different human organs, including the central nervous system and adipose tissue. The aim of this study is to estimate Apelin levels in diabetes type 2 and Diabetic peripheral Neuropathy (DPN) Iraqi patients and show the extent of peripheral nerve damage. The current study included 120 participants: 40 patients with Diabetes Mellitus, 40 patients with Diabetic peripheral Neuropathy, and 40 healthy

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Publication Date
Wed May 10 2023
Journal Name
Dermatology Research And Practice
Interleukin-15 and Tumor Necrosis Factor-α in Iraqi Patients with Alopecia Areata
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Background. Alopecia areata (AA) is a common form of noncicatricial hair loss of unknown cause, affecting 0.1-0.2% of the general population. Most evidence supports the hypothesis that it is disease of the hair follicle of autoimmune nature mediated by T-cells, with important cytokine role. Objective of the Study. The objective of this study is to study the association and changes in serum levels of interleukin-15 (IL-15) and tumor necrosis factor-α (TNF-α) in patients with AA in relation to the type, activity, and disease duration. Patients and Methods. Thirty-eight patients with AA and 22 individuals without the disease as controls were enrolled in this case-controlled study conducted in the Department of Dermatology in the Al-K

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Publication Date
Sun Apr 30 2023
Journal Name
Al-kindy College Medical Journal
Pharmacist Intervention to Address Drug Related Problems in Patients with Decompensated Liver Cirrhosis
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Background: Patients with decompensated cirrhosis are often given therapeutic and prophylactic drugs. Polypharmacy raises both the likelihood of prescription errors and the complications associated with drugs. Clinical pharmacists are excellent at recognizing, addressing, and preventing clinically significant drug-related problems.

Objectives: Identification types of pharmacist interventions to address drug-related problems in patients with decompensated cirrhosis and assess the acceptance/implementation of these recommendations. And identify patient factors associated with accepting pharmacist recommend

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Publication Date
Tue Jun 15 2021
Journal Name
Al-academy
Shorthand the representative performance in the theatrical festival performances of the education teams for teachers in primary schools , in secondary schools and artistic supervisors 2019 AD: خضر عبد خضير
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Arts acts to reduce and exclude everything that is not necessary in the delivery of meaning, especially representative performance, which is based on the intensification of the physical and vocal actions, and in drawing the dimensions of the character. And because that, the artistic staff, among others in the ministry of education, are considered the cornerstone, in the development of theatrical activities in schools, this research came to find out the extent to which teachers in primary schools, in secondary schools and artistic supervisors rely on shorthand mechanisms in the representative performance.
The current research relied on the descriptive approach, in analyzing his sample, which was deliberately chosen, Among the most imp

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Publication Date
Wed Jun 10 2020
Journal Name
Annals Of Tropical Medicine & Public Health
EFFECT OF EUCALYPTUS AND MYRTUS EXTRACTS IDENTIFICATION BY GAS CHROMATOGRAPHY-MASS SPECTROMETRY ON SOME SPECIES OF CANDIDA AS A MODEL OF MEDICAL PLANTS
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The study showed that all extracts (aqueous, ethanolic and acetonic) of the leaves of Eucalyptus and Myrtus plants had a inhibitory effect on the growth of all types of yeasts studied, acetone extract recorded the highest inhibition of yeastat 100ppm concentration,The inhibition was 35mm, 34mm, 24mm and 20mm for Candida parapsilosis, Candida glabrata, Candida tropicalis and Candida albicans respectively, The experiments above showed the least significant differences at 0.05 level.The results ofE. Cammldulensis ethanolic tincture analysis has shown the presence of 44 biologically active substances. The main Eucalyptus leaves component was: 2-Bicyclo (2-2.1) heptanol (12.37%), Ledol (8.23%),1,2,4- Benzenetriol (8.45%) and that contain spathul

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Wed Jan 01 2020
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EFFECT OF EUCALYPTUS AND MYRTUS EXTRACTS IDENTIFICATION BY GAS CHROMATOGRAPHY-MASS SPECTROMETRY ON SOME SPECIES OF CANDIDA AS A MODEL OF MEDICAL PLANTS
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Publication Date
Sat Sep 15 2018
Journal Name
Journal Of Baghdad College Of Dentistry
Prosthetic Status in Relation to Weight Status and Occupation among Parkinson's Disease Patients in Baghdad-Iraq
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Background: The symptoms of Parkinson's disease (PD) can lead to problems in movement and coordination that lead to difficulty in maintaining well oral cleaning which can then negatively affect dental status of those Patients. The aim of present study: To evaluate prosthetic status in relation to weight status and occupation by age and gender among Parkinson's disease Patients in Baghdad-Iraq. Methods: The sample consisted of 104 patients with Parkinson disease attended to the Neurosciences Hospital in Baghdad city / Iraq, aged 60-79 years Prosthetic Status was recorded according to WHO(1997). Weight status was recorded according to Trowbridge 1988 and occupation was recorded according to Erikson and Goldthorpe (1992) and Ganzeboom et al (

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Publication Date
Wed Jan 01 2020
Journal Name
Annals Of Tropical Medicine And Public Health
Volumetric assessment of maxillary sinus in cleft lip and palate patients in comparison to normal subjects
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