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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 Mar 29 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Serum Trace Elements (Zinc, Copper and Magnesium) Status in Iraqi Patients with Acne Vulgaris :( Case- Controlled Study)
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Recently on the dermatological fields, the serum levels and the roles of Zn, Cu and Mg have been studied especially in acne vulgaris, but the results were controversial. The aim of the present study is to investigate  a relationship between the severity of acne and the serum levels of zinc (Zn), copper (Cu) and magnesium (Mg) and to demonstrate the status of serum levels of zinc, copper, and magnesium in Iraqi male patients with acne vulgaris and to compare it with those of healthy controls.This case controlled study was conducted in the Department of Dermatology and Venerology and in the Poisoning Consultation Center of Baghdad Teaching Hospital between May 2009 to January 2010. Forty- five male patients with acne vulgaris, their a

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Publication Date
Wed Apr 08 2020
Journal Name
Biochemical & Cellular Archives .
PURIFICATION OF RHODANESE (RHD) AND ITS ASSOCIATION WITH MDA AND PEROXYNITRITE IN PATIENTS WITH TYPE II DIABETES.
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Publication Date
Thu May 01 2025
Journal Name
Biochemical And Celuular Archives
Interleukin-38 (il-38) is a Novel Biochemical Marker in Sera of Iraqi Patients with Alzheimers Disease
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ABSTRACT : Alzheimer’s disease (AD) is one of the most common inflammatory neurodegenerative diseases linked with dementia, it is characterized by the deposition of amyloid beta-peptide (Ab) in the brain. The present study aims to innovate a biochemical relationship between AD and interleukin 38 (IL-38) as an anti-inflammatory cytokine, expose novel mechanisms and concepts regarding other biochemical parameters studied previously or recently in AD patients and also examine the biochemical action of memantine (10 mg daily) on AD patients. Sixty (60) diagnosed AD patients participated in the present study and classified into four (4) groups: G3 were composed of (15) newly diagnosed males (52-78) years / without treatment, G4 composed of (15

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Publication Date
Wed Apr 30 2014
Journal Name
Ibn Al-haitham Journal For Pure And Applied Sciences
Relationship Between Interleukin -33( IL-33) and C- Reactive Protein in Iraqi Women Patients with Celiac Disease
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Interleukin -33 is a new member of the IL-1 superfamily of cytokines that is expressed mainly by stromal cells.Its expression is upregulated following pro-inflammatory stimulation.Aim of the present study was to assess the serum IL-33 level and its relationship with inflammatory biomarker CRP in Iraqi females patients with celiac disease. Thirty five patients with celiac disease (CD) and thirty healthy individuals as control group were enrolled in this study,their age ranged (20-35) year.Anti-Gliadin IgA ,IgG and Anti-Tissue IgA ,IgG were estimated in all subjects as diagnostic parameters .ESR and CRP were assayed as inflammatory biomarkers. IL-33 was determined in patients and control groups.The results of the present study revealed a hig

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Publication Date
Wed Feb 01 2023
Journal Name
Baghdad Science Journal
Potential Role of 8-Hydroxyguanosine and some Pro Inflammatory Cytokines as Biomarkers in Colorectal Cancer Iraqi Patients
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8-hydroxyguanosine (8-OHdG) is considered as an indicator of the oxidative stress. Pro inflammatory cytokines are critical parts of the pathophysiological processes to which treatment can be applied. The aim of this study was to evaluate 8-OHdG and pro inflammatory cytokines concentration in colon carcinoma patients. Blood samples were taken before treatment from 50 incident cases with colon cancer (stage III) admitted for health examination at the Nanakali Hospital in Erbil city with 45 healthy samples of controls with age range between 38-69 years for both groups. All studied parameters were estimated by ELISA. Participants at this study were 95 Participants ranged in age from 38 to 69 years, 50 Participants had been newly diagnosed wi

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Publication Date
Tue Dec 02 2025
Journal Name
Journal Of Baghdad College Of Dentistry
The prevalence of Candida spp. in the saliva of controlled and uncontrolled diabetes mellitus type II patients
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Background: Diabetes mellitus type 2 has been known for many years as the most common endocrine metabolic disorder that affect the oral cavity and cause many oral diseases including candidiasis. In this study, the incidence of Candida spp. in the saliva of controlled and uncontrolled diabetic patients were determined and compared with non diabetic group. Material and method: The sample consists of 200 subjects: 100 diabetic patients [57 (28.5%) uncontrolled diabetes, 43 (21.5%) controlled diabetes] and 100 (50%) non diabetic groups. Saliva samples was obtained from the subjects and cultured on selective media using appropriate microbiological method to observe the presence of Candida spp. Results: The results revealed a significant associat

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Publication Date
Sun Dec 04 2016
Journal Name
Baghdad Science Journal
Study the Oxidative Stress, Some Biochemical and Hematological Parameters in patients with agout at AL-Ramadi city
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This study aims to study the effect of gout disease on complete blood picture and biochemical parameters and some non-enzymatic antioxidants, some tracing elements and lipid peroxidation ,in outpatients with gout disease at Al-Ramadi Teaching-Hospital ,Al-Razi Hospital and the study duration from Octo.2013-to May 2014.(50) blood samples were collected from patients with age groups (30-80 years) from both sexes (28 males,22 females),a (30) blood samples (15 males,15 females) were collected from normal individuals as a control group with age groups (27-75 years). Hematological measurement showed no significant differences in size compressed blood cells, the percentages in ( 45.15 +4.99 and 46.87+6.30) % in patient and control groups respect

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Publication Date
Mon May 06 2024
Journal Name
Journal Of Pakistan Association Of Dermatologists
Assessment of tumor necrosis factor alpha and interleukinـ10 in obese psoriatic patients before and after using apremilast
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Background Psoriasis is one of the most prevalent chronic inflammatory skin conditions; its prevalence ranges from 1 to 3%. Tumor necrosis factor-alpha (TNF-α), a cytokine that enhances inflammation, is overexpressed in synovium and skin plaques in psoriasis. TNF-α plays a critical role in the pathogenesis of psoriasis. IL-10 is the most crucial cytokine for reducing excessive immune responses and decreasing pro-inflammatory reactions in all autoimmune disorders.   Objective To evaluate the effect of Apremilast on ILـ10, TNFـα, and BMI in obese psoriatic patients.   Methods Thirty patients included in this investigative study to measure the concentrations of TNFـα, ILـ10 and BMI, before and after receiving Apremilast. TNFـα and

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Publication Date
Sat Aug 17 2024
Journal Name
International Academic Journal Of Applied Bio-medical Sciences
Review of Relationship of Acanthamoeba spp. With some Species of bacteria in lenses lesion from Iraqi patients
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The dangerous and potentially blinding condition known as Acanthamoeba keratitis is caused by free-living amoebae of the genus Acanthamoeba. The prevalence of AIDS patients and contact lens wearers has increased in recent years, making cannaeba infections more significant. It's interesting to note that, depending on the parasite, host, and environmental conditions, the pathways linked to Acanthamoeba pathogenesis are frequently extremely complex. Notwithstanding our progress in antibiotic therapy and supportive care, the prevalence of Acanthamoeba keratitis has not decreased

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Publication Date
Fri Sep 11 2020
Journal Name
Egyptian Journal Of Medical Human Genetics
Evaluating of the association between ABO blood groups and coronavirus disease 2019 (COVID-19) in Iraqi patients
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Abstract<sec> <title>Background

Susceptibility to the pandemic coronavirus disease 2019 (COVID-19) has recently been associated with ABO blood groups in patients of different ethnicities. This study sought to understand the genetic association of this polymorphic system with risk of disease in Iraqi patients. Two outcomes of COVID-19, recovery and death, were also explored. ABO blood groups were determined in 300 hospitalized COVID-19 Iraqi patients (159 under therapy, 104 recovered, and 37 deceased) and 595 healthy blood donors. The detection kit for 2019 novel coronavirus (2019-nCoV) RNA (PCR-Fluorescence Probing) was used in the diagnosis of disease.

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