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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
Wed Apr 12 2023
Journal Name
Iraqi Postgraduate Medical Journal
The Accuracy of Electrocardiographic Criteria for Predicting Left Ventricular Hypertrophy in adult Patients with Systemic Hypertension
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ABSTRACT: BACKGROUND: Left ventricular hypertrophy is a significant risk factor for cardiovascular complications such as ischemic heart disease, heart failure, sudden death, atrial fibrillation, and stroke. A proper non-expensive tool is required for detection of this pathology. Different electrocardiographic (ECG) criteria were investigated; however, the results were conflicting regarding the accuracy of these criteria. OBJECTIVE: To assess the accuracy of three electrocardiographic criteria in diagnosis of left ventricular hypertrophy in adult patients with hypertension using echocardiography as a reference test. PATIENTS AND METHODS: This is a hospital-based cross sectional observational study which included 340 adult patients with a his

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Publication Date
Thu Apr 01 2021
Journal Name
Biochemical And Cellular Archives
STUDY OF LYSYL OXIDASE-1 AND KIDNEY FUNCTION IN SERA OF IRAQI PATIENTS WITH DIABETIC NEPHROPATHY
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This study aimed to compare lysyl oxidase-1 level in diabetic patients with and without renal dysfunction, that LOX-1 may be an indicator for the early stage of diabetic nephropathy (DN). In addition to finding it is a relationship with kidney functions in Iraqi diabetic patients with and without renal dysfunction. Blood was obtained from 25 healthy individuals as a control group (G1), 25 diabetic patients with renal dysfunction, and 25 diabetic patients without renal dysfunction. Age range 40-60 years for all subjects. BMI (25-27) Kg/m2 . The serum was used for the analysis of LOX-1, FBG, urea, creatinine and uric acid. Whole blood is used for the determination of HbA1C. Results of FBG and HbA1C revealed a significant increase in G2 and G

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Publication Date
Sat Jan 01 2022
Journal Name
Annals Of Parasitology
Serum levels of C-reactive protein and ferritin in COVID-19 patients infected with Toxoplasma gondii
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During infection, T. gondii disseminates by the circulatory system and establishes chronic infection in several organs. Almost third of humans, immunosuppressed individuals such as HIV/AIDS patients, cancer patients, and organ transplant recipients are exposed to toxoplasmosis. Therefore, the study aimed to investigate the possibility that Toxoplasma infection could be a risk factor for COVID-19 patients and its possible correlation with C-reactive protein and ferritin. Overall 220 patients referred to the Al Furat General Hospital, Baghdad, Iraq were enrolled from 2020–2021. All serum samples were tested for T. gondii immunoglobulins (IgG and IgM) antibodies, C-reactive protein and ferritin levels. In patients with COVID-19, the results

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Publication Date
Wed Jan 01 2020
Journal Name
Annals Of Tropical Medicine And Public Health
The impact of JAK2V617F allelic burden on clinical and laboratory parameters in patients with myeloproliferative neoplasms
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Publication Date
Wed Mar 29 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Evaluation of Metformin + Sitagliptin versus Metformin + Glibenclamide on Glycemic Control in Iraqis Type 2 Diabetic Patients
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Combination therapy with a dipeptidyl peptidase–4 inhibitor and metformin or metformin+ glibenclamide results in substantial and additive glucose- lowering effects in Iraqis patients with type 2 diabetes mellitus . This study evaluated the glycemic control by using two groups of  combinations of drugs metformin + glibenclamide and metformin + sitagliptin in Baghdad teaching hospital / medical city. 68 T2DM patients and 34 normal healthy individuals as control group were enrolled in this study and categorized in to two treatment groups. The group 1 (34 patients ) received ( metformin 500 mg three times daily + glibenclamide 5 mg twice daily ) and the group 2 (34 patients) received (metformin 500 mg three times daily + sitaglip

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Publication Date
Wed Mar 29 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Evaluation of Trace Elements in Iraqi Patients with Rheumatoid Arthritis by using Atomic Absorption Spectrophotometer (AAS)
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Zinc, Copper, Selenium, Magnesium, Manganese, Chromium, Iron, Nickel, Cobalt, Vanadium and Germanium were determined by atomic absorption spectrophotometer (AAS) in blood serum of patients with rheumatoid arthritis, (30) patients (14male and 16female) with age range (37-60) years compared with normal tensive control. The analysis of results showed that the mean value of concentration (Magnesium,  Manganese and Nickel) were significantly higher in patients with rheumatoid arthritis compared to that of healthy, while the mean levels of serum (Zinc, Copper, Selenium, Chromium, Iron, Cobalt and Germanium) were significantly lower than controls. There were no significant changes in overall mean concentration of serum Vanadium in patients

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Publication Date
Thu Jun 15 2023
Journal Name
Bionatura
Copper-to-Zinc Ratio as an Inflammatory Marker in Serum of Iraqi Patients with Axial Spondyloarthritis
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Axial spondyloarthritis (axSpA) is a chronic rheumatic inflammatory disease affecting mainly the spine and sacroiliac joints. Since the copper-to-zinc ratio (Cu/Zn) indicates an inflammatory response, the change in ratio is expected to correlate with axSpA. This study compared levels of Cu/Zn in the serum of axSpA patients. Serum samples were obtained from 53 patients with axSpA divided according to biological treatment into cohorts A and B, and 28 healthy control as cohort C. Serum levels of Cu and Zn were determined first by a fully automated chemistry analyzer TC-Matrix Plus, then the ratio was obtained. The elevated serum Cu concentration means of cohort B (189.32 ± 13.808 µg/dL) compared to cohort A (168.85 ± 7.244 µg/dL) a

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Publication Date
Thu May 05 2022
Journal Name
Al-kindy College Medical Journal
Evaluation of podophyllin and Trichloroacetic acid for the treatment of genital warts in Iraqi female patients
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Background: human paillomavirus infections (genital warts) are the most frequent sexually transmitted viral infections. a wide range of treatment options is available with different efficacy.

Objective: To evaluate the efficacy of podophyllin, trichloracetic acid (TCA) in the treatment of genital warts and side effects of them.

Subjects and methods: a total of sixty patients with genital warts were randomly selected, 30 in each group, in the Department of Dermatology, medical city for a Duration of 11 months from January 2009 to December 2009 treated with 35 % podophyllin in the tincture of benzoin or 50%  TCA) .Forty-eight patients were followed up for three months.

Results: wart

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Publication Date
Thu Oct 03 2013
Journal Name
J. Of University Of Anbar For Pure Science
Determination of thyroid hormone levels in the serum of Non- dialyzed patients with chronic renal failure
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Thyroid hormones, triiodothyronine (T3) and thyroxin (T4) play an important role in growth, development, and physiology of the kidney. The kidney has a central role in metabolism and clearance of these hormones as well as thyroid – stimulating hormone (TSH). Chronic renal failure (CRF) is a state of irreversible deceleration in renal function results in alterations in internal milieu, which affects the synthesis and secretory rate of hormones. To evaluate the thyroid hormone levels in non-dialyzed patients with chronic renal failure (CRF); 24 patients with CRF aged 30-70 years, mean±S.d. (48.458 ± 13.569) and 48 healthy volunteers who served as controls aged 30-70 years (43.104 ± 12.387) were studied for their thyroid function status u

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Publication Date
Tue Sep 26 2017
Journal Name
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Effects of cranberry-PACs against urinary problems associated with radiotherapy in iraqi patients with bladder carcinoma
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