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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 Jan 20 2018
Journal Name
International Journal Of Medical Research & Health Sciences
The Influence of Thyroid Hormones on Leptin and Resistin Levels in Hyperthyroid Female Patients
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Hyperthyroidism or thyrotoxicosis occurs due to excess release of thyroid hormone. These hormones regulate the body’s energy balance and have effects on adipokine level. There are several reports suggesting interrelation between adipokines (resistin and leptin) with thyroid dysfunction. Objectives: This study was established to investigate the effect of thyroid hormones in hyperthyroidism state on the level of some adipokines, leptin and resistin; in comparison with control. Patients and Methods: The present study included 50 Iraqi female patients with hyperthyroidism with age ranged between 30-58 years and 30 healthy controls with age ranged between 30-53 years. Serum samples were collected from study groups. The levels of thyroid hormon

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Publication Date
Fri Jan 01 2021
Journal Name
Pakistan Journal Of Medical And Health Sciences
Comparison of 1, 25-Dihydroxyvitamin D3 and Glutathione Reductase Levels in Thyroid Gland Patients
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Publication Date
Sat Mar 04 2017
Journal Name
Baghdad Science Journal
Measurement and purification of Alanine aminotransferase (ALT) enzyme activity in patients with celiac disease
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Celiac disease (CD) is the most common genetically - based disease in correlation with food intolerance. The aim of this study is to measure the activity of ALT enzyme and purify enzyme from sera women with celiac disease. Alanine aminotransferase (ALT) activity has been assayed in (30) women serum samples with celiac disease, age range between (20-40) year and (30) serum of healthy women as control group, age range between (22-38) year. In the present study, the mean value of ALT activity was significantly higher in patients with celiac disease than healthy group (p<0.01). The ALT enzyme was partial purified from sera women with celiac disease by dialysis, gel filtration using Sephadex G- 50 and ion exchange chromatography using DEAE- cell

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Publication Date
Sun Nov 01 2020
Journal Name
Pakistan Journal Of Medical And Health Sciences
Impact of smoking on cardiac electrophysiological parameters of symptomatic sinus node patients in Iraq
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Background: Dysfunction of sinoatrial node is a set of abnormal rhythms which are resulted from the sinoatrial node malfunction of the sinus node, the chief natural cardiac pacemaker. The common, and occasionally, the single method for treatment of heart arrhythmias was implantation of pacemaker, which reduce symptoms exactly occurs after implantation. Aim: To detect the role of smoking on cardiac electrophysiology parameters in sinus node dysfunction in Iraqi patients such as SNRT and AH. Methods: A cross sectional study, was conducted on 59 patient ranging between 20-50 years old and involving 35 female and 24 male patients, suffering from an unexplained symptoms of sinoatrial node dysfunction (SND). The enrolled participants were gathere

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Publication Date
Fri Jun 30 2023
Journal Name
Diyala Journal Of Medicine
Correlation with renin-angiotensin-aldosterone and glomerular filtration rate in chronic renal failure patients
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Background: One of the more significant hormonal systems, the renin-angiotensin-aldosterone system, controls the kidney function, adrenal gland through its effect on the balance of sodium and potassium, blood pressure, fluid volume, and also manages the functions of cardiovascular. Objective: To clarify the interrelationship between renal dysfunction and renin-angiotensin-aldosterone system. Patients and Methods: One hundred samples were collected from December 1, 2022, to February 18, 2023, from Al Shams Medical Laboratories (56 male, and 44) female, age range (of 45-60 years), all of them were volunteers suffering from chronic renal failure in the third stage the average glomerular filtration rate was 35. 70 ± 0.37 12

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Publication Date
Mon Jan 01 2018
Journal Name
Journal Of Global Pharma Technology
Estimation of Some Trace Elements and Antioxidant Status in Breast Cancer Patients Undergoing Radiotherapy
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Breast cancer (BC) is the most prevalent tract cancer in the world, including Iraq. The classified breast tumors to benign, malignant, and radiotherapy. Cancer treatment depends on certain stages such as mastectomy then chemotherapy alone or with radiation therapy or endocrine therapy according to the prognostic features obtained from the pathology report. The present study included 100 females. The women were split into two groups, control group that consisted of 50 apparently healthy females and 50 patients with BC group who undergo the radiotherapy. The current study highlighted on some of the anthropometric measurements, including the oxidative stress index malondialdehyde (MDA), the concentrations of total antioxidant capacity (TAC), s

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Publication Date
Wed Nov 07 2018
Journal Name
Iraqi National Journal Of Nursing Specialties
Quality of Life among Adult Patients with Peptic Ulcer in the City of Sulaimani
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Objectives: To assess the quality of life for adult patients with peptic ulcers in the city of Sulaimani.
Methodology: A descriptive study, using the assessment approach was conducted on patients with peptic ulcer
disease from January 12th, 2009 to September 30th, 2009. A purposive "non-probability" sample of (100) paƟents
(males and females) with peptic ulcers who attended Kurdistan Center for Gastroenterology and Hepatology were
selected for the study. A questionnaire was adapted from the World Health Organization quality of life questionnaire
(1998) for the purpose of the study. It is comprised of (3) parts that included sociodemographic characteristics form,
medical history form and adult peptic ulcers patients' qu

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Publication Date
Wed Mar 18 2020
Journal Name
Baghdad Science Journal
Biomarker Significance of Serum CXCL8, CXCL10 and CXCL16 in Breast Tumors of Iraqi Patients
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The biomarker significance of three chemokines (CXCL8, CXCL10 and CXCL16) was evaluated in sera of 45 breast cancer (BC) and 28 benign breast lesion (BBL) patients, as well as 20 control women. Clinical stage and tumor expression of estrogen (ER), progesterone (PgR) and human epidermal growth factor receptor-2 (HER-2) receptors were considered in this evaluation. The results demonstrated that CXCL8, CXCL10 and CXCL16 showed a significant increased median in BC and BBL patients compared to control (CXCL8: 47.3 and 25.7 vs. 15.0; CXCL10: 37.6 and 30.7 vs. 13.1; CXCL16; 27.9 and 25.2 vs. 19.2 pg/ml, respectively). The increased levels of CXCL8 and CXCL16 were more pronounced in triple-negative and HER-2 positive p

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Publication Date
Thu Nov 01 2018
Journal Name
Iraqi National Journal Of Nursing Specialties
Assessment of Asthmatic Patients’ Quality Of Life in Jordan Fadel Hazza' Ali al-Mahameed.*
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Abstract A descriptive study was conducted in Al-Bashir teaching hospital in Amman city from 15th May 2004 to 15th August 2004 , in order to "Assess the adult asthmatic patients’ quality of life (QOL). Objective: This study aimed at identifying the domains of (Environmental, Physical, Daily Living Activity, Drug and Medication, Psychological , and Social), Methodology : A Purposive (Non-Probability) sample of (100) adult asthmatic patients visited the emergency department and outpatient clinic of chest department in Al-bashir hospital .A Questionnaire was constructed for the purpose of the study, and compris

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Publication Date
Wed May 28 2025
Journal Name
Oxidation Communications
ESTIMATION OF GALECTIN-3 IN TYPE-2 DIABETIC PATIENTS AFTER VACCINATED AGAINST COVID-19"
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The rapid spread of the COVID-19 coronavirus in 2019 infected many people, primarily affecting the respiratory system. Both COVID-19 and type 2 diabetes have been associated with numerous risks that have become life-threatening. The study studied the link between galectin levels and some clinical characteristics in Iraqis with type 2 diabetes and COVID-19 against those without diabetes. The study included 120 patients and healthy men. Three groups were formed for this study depending on the initial mutant cell line: 80 samples of individuals with type 2 diabetes, aged 40–60 years, with and without COVID-19, were included in each of the first and second groups. The control group consisted of 40 research participants who were matched for ag

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