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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 Dec 05 2010
Journal Name
Baghdad Science Journal
Immunoglobulins assessment (IgE,G,A,M) in some Iraqi patients with acute and chronic urticaria
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60 patients diagnosed as having urticaria were included in the study ; 30 patients were effected with acute urticaria and 30 patients were affected with chronic urticaria. In addition, 30 healthy adult volunteers were selected as control group .The patients and control groups sera were examined with enzyme linked immunosorbent assay ( ELISA) to detect total level IgE and radial immunodiffusion (RID) to detect levels of IgG , IgA and IgM . The total level of IgE in acute urticaria ( 1.45±0.13) IU/mL and chronic urticaria (2.12 ± 0.10) IU/mL patients were significantly higher than the control groups ( 0.85 ± 0.10)IU/mL (p<0.05). The level of IgG in acute urticaria ( 12.5± 0.42) g/L and chronic (13.16±0.40) g/L patients , IgA in acute (2.

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Publication Date
Sun Jun 01 2014
Journal Name
Baghdad Science Journal
Evaluation of protein level’s changes in saliva and sera of Oral Squamous Cell Carcinoma patients
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This study aimed to identify the changes in total protein in saliva and sera samples of patients with oral squamous cell carcinoma in comparison to those of healthy controls. These changes were followed using electrophoresis (PAGE). Meanwhile, determinations of albumin, globulin and albumin to globulin ratio were carried out on sera samples only.Two groups were the participants in the present study, 18 patients with Oral Squamous Cell Carcinoma (OSCC), and 20 ages and gender matched healthy controls.

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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)
Quality of Life of Patients with Type II Diabetes Mellitus in Al- Hilla City-Iraq
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Diabetes mellitus is a global problem nowadays due to increase the disease cases all over the world, in both the developed and developing countries which may affect the quality of life (QOL ) of diabetic patients. This study was conducted to assess the quality of life of patients with type 2 diabetes mellitus (DM) and to determine some selected clinical and sociodemographic factors that affect the quality of life of these patients in Al Hila city-Iraq. This was a cross sectional study in which 100 patients with type 2 diabetes mellitus attending diabetic outpatient clinics of Merjan Teaching Hospital-Al Hila. To assess the quality of life of those diabetic patients, the World Health Organizations Quality of Life Assessment (WHOQOL) was a

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Publication Date
Thu Sep 12 2019
Journal Name
Al-kindy College Medical Journal
Toll like receptor 2(TLR2) in acne vulgaris patients before and after oral isotretinion therapy
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Background: Acne vulgaris is one of the top three most commonly encountered dermatological problems worldwide in both primary and secondary care. Human keratinocytes express functional TLR2 heterodimers. An increased expression of TLR2 was detected in the epidermis of inflammatory acne lesions, as observed in normal skin; the expression level increased with the degree of differentiation of the keratinocytes. TLR2 expression is upregulated in inflammatory acne lesions and induced by C. acnes. The current study conducted to assess the oral isotretinion treatment effect on the acne vulgaris patients by  evaluated the Toll Like Receptor 2 as a major  immune system marker in Acne vulgaris immune re

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Publication Date
Tue Jan 01 2019
Journal Name
Annals Of Tropical Medicine And Public Health
ASSOCIATION BETWEEN AUTOPHAGIC FLUX AND INFLAMMATION MARKERS IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING METHOTREXATE AND INFLIXIMAB
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Publication Date
Thu Mar 30 2023
Journal Name
Al-mustansiriyah Journal Of Science
CA72-4 as a Promising Prognostic and Diagnostic Biomarker in Iraqi Patients with Colorectal Cancer
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Colorectal cancer (CRC), the second most fatal cancer and the 3rd most common cancer is expected to cause 0.9 million deaths globally in 2025. Carcinoembryonic antigen (CEA) is currently used in the follow-up of patients with colorectal cancer, and in this study, we are trying to find a better marker than CEA in following up on patients' health and knowing the effectiveness of the treatment used and as a diagnostic marker for colorectal cancer. To determine the significance of Cancer antigen 72-4 (CA72-4) as a prognosis predictor in patients with colorectal cancer, compare its prognostic validity to the CEA biomarker. this case-control study includes (150) participants, 100 patients (59 males and 41 females), and 50 healthy controls

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Publication Date
Tue Dec 01 2020
Journal Name
Annals Of Tropical Medicine And Public Health
Endoscopic Partial Lateral Middle Turbinectomy versus middle Turbinat Trimming in Adult patients with Concha Bullosa
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Background: Concha bullosa is an anatomical variation which defined by pneumatizaton of middle turbinate that occurred with an incidence of (5 to 25%) in the normal population.It has the potential to cause crowding and obstruction of the middle meatus and nasal cavity. There are many surgical techniques which utilized for its management. Study goal: Is to compare the formation of adhesion between endoscopic partial lateral middle turbinectomy and middle turbinate trimming in cases of concha bullosa. Patients and methods: A prospectivecomparative clinical trial was performed in the ENT department at Al-Shahid Ghazi AL Hariri Hospital in Medical City over the period from September 2016 to August 2017. Fifty nine (59) patients {24 males

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Publication Date
Wed Apr 01 2020
Journal Name
The Egyptian Rheumatologist
Predictive significance of CXCL8, CXCL10 and CXCL16 in juvenile idiopathic and rheumatoid arthritis Iraqi patients
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Publication Date
Mon Dec 01 2025
Journal Name
Journal Of Baghdad College Of Dentistry
Oral manifestation biochemical and IgA analysis of saliva in hyperthyroid (Grave’s disease) patients(Comparative study)
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Background: Hyperthyroidism occurs due to over production of thyroid hormones, one types of hyperthyroidism was Graves, disease. Hyperthyroidism is characterized by high level of serum thyroxin, triiodothyronine and low level of thyroid stimulated hormones. Material and Methods: fifty two hyperthyroid patients, thirty patients under treatment with carbimazole and other twenty two patients under treatment with radioactive iodine, and sixty healthy control group. The average salivary flow rate was calculated as ml/5mint.The concentration of calcium, potassium, and total protein were determined in the salivary supernatant sample. This is done through different biochemical tests. Determination of salivary IgA is done by ELIZA. Results: The most

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Publication Date
Thu Jan 30 2014
Journal Name
Al-kindy College Medical Journal
THE PREVALENCE AND ANTIMICROBIAL RESISTANCE OF PSEUDOMONAS SPECIES IN PATIENTS WITH CHRONIC SUPPURATIVE OTITIS MEDIA
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Background: Chronic suppurative otitis media (CSOM) is the result of aninitial episode of acute otitis media and is characterized by a persistent discharge from the middle ear through a tympanic perforation for at least 2 weeks duration. It is an important cause of preventable hearing loss, particularly in the developing world.Methods. 1. To get an overview on the bacterial ear infection profile in general 2. To assess the antibiotic resistance of Pseudomonal infection (PS) particularly since it is usually the commonest infection to cause otitis media and the most difficult to treat due to the problem of multi drug resistance... A cross sectional study was done which included 405 patient of CSOM patients196 (48%) case were males ,209 (52

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