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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 Mar 07 2010
Journal Name
Baghdad Science Journal
Relation between Serum Leptin, Lipid Profiles and other biomarkers levels in patients with type 2 diabetic nephropathy
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Background: In advanced diabetes mellitus, serum levels of the most hormones are altered due to several interplaying mechanisms. Objective: To assess the relation of serum leptin and lipid profile in type 2 diabetic nephropathy. Patients and Method: Serum leptin levels and its relation to lipid profile were estimated in 62 patients with type 2 diabetic nephropathy attending the National Diabetes Center in Al- Mustansiriya University, and (26) healthy individuals considered as control group. The diabetic patients were classified into three groups, (24) pathients with normoalbuminuria (21) patients with microalbuminuria and (17) patients with macroalbuminuria. Fasting plasma glucose, serum creatinine, Hb A1c %, lipid profile (Total c

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Publication Date
Thu Oct 13 2022
Journal Name
Plant Archives
ISOLATION AND SERODIGNOSTIC OF VIBRIO CHOLERAE FROM PATIENTS SUFFERED FROM WATERY DIARRHEA IN SUWAYRAH, WASIT GOVERNORATE, IRAQ
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Background: Cholera has been recognized as a killer disease since earliest time. The disease is caused by infection of the small intestine by Vibrio cholerae O1 and O1391 which is characterized by severe dehydrating diarrheal condition and is one disease in modern times that is epidemic, endemic and pandemic in nature. Objective: This study was carried out to detect and isolate V. cholerae from patients suffered from watery diarrhea, which may cause severe complications such as dehydration, shock followed by death. Materials and methods: stool specimens were collected from 308 patients with watery diarrhea. These samples were tested with many criteria such as TCBS agar, gram stain, biochemical tests and VITEK-2 system to improve the isolati

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Publication Date
Sun Jun 04 2023
Journal Name
Iraqi Journal Of Biotechnology,
Gene Expression of Adenosine Deaminase Genes 1 and 2 in Female Iraqi Patients with Autoimmune Thyroid Disease
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The current study was carried out to investigate the correlation of gene expressions of ADA1 and ADA2 genes with the development of autoimmune thyroid disease (AITD) in a sample of Iraqi females. One hundred patients with AITD and 80 controls were included. Quantitative real time polymerase chain reaction (qRT–PCR) was utilized for investigation of ADA1 and ADA2 gene expression among patients and controls. The correlation of age and body mass index (BMI) with AITD occurrence comparing with controls was studied. Based on the results of this study, there is high expression level of ADA1 and ADA2 genes in patients compared with healthy controls; also, the gene expression fold (2-ΔΔCT) of ADA1 and ADA2 among AITD patients was recorded and a

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Publication Date
Tue Oct 01 2019
Journal Name
Biochemical & Cellular Archives
PREDICTIVE VALUES OF DHEAS, TT AND IGF1 IN SUCCESSFUL PREGNANCY OUTCOME OF PATIENTS UNDERGOING IVF/ICSI-ET
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vitrofertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) for infertile patients. Insulin like growth factor 1 (IGF1), Dehydroepiandrosterone sulfate (DHEAS) and Total Testosterone (TT) may have a role on follicle growth, oocyte quality, embryo quality and subsequent pregnancy in patients undergoing IVF cycles. To explore the possibility of using DHEAS, TT and IGF1 as predictive indicator for successful pregnancy in patients undergoing (IVF/ICSI-ET). A prospective study was performed enrolling (12) non pregnant control group,(7) pregnant control group,(18) non-pregnant PCOS group and (12) pregnant PCOS group. The collection of blood and follicular fluid (FF) samples was done at the day of oocyte aspiration. Electroch

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Publication Date
Sun Jun 07 2015
Journal Name
Baghdad Science Journal
Optimization of Glutathione S-Transferase in the Sera of Young Female Iraqi Patients with Diabetes Mellitus Type1
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This study was attempted to determine optimum conditions, for Glutathione s-Transferase enzyme, in sera of three groups diabetic patients type1 depending on duration of disease without complications compared with control group. The aim of this study was to find optimum conditions were determined such as (pH, Substrate Concentration, Temperature, Incubation time, Enzyme concentration, and effect of(0.15M)(0.25M) of mono divalent compounds). And to find the kinetics parameters in the three groups of diabetic patients when compared with control. It was found optimum pH(8.5,4.5,2.5,6.5).Temperatures(20cº,40cº,50cº,30cº). Incubation times (7min, 4min, 4min, 5min) substrate concentrations (12µl, 10µl, 5µl, 10µl) enzyme concentra

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Publication Date
Mon Dec 01 2014
Journal Name
Iraqi Journal Of Science,
Detection of human leukocyte antigen and celiac disease auto antibodies in serum of patients with multiple sclerosis
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To determine the important pathogenic role of celiac disease in triggering several autoimmune disease, thirty patients with Multiple Sclerosis of ages (22-55) years have been investigated and compared with 25 healthy individuals. All the studied groups were carried out to measure anti-tissue transglutaminase antibodies IgA IgG by ELISA test, anti-reticulin antibodies IgA and IgG, and anti-endomysial antibodies IgA and IgG by IFAT. There was a significant elevation in the concentration of anti-tissue transglutaminase antibodies IgA and IgG compared to control groups (P≤0.05), there was 4(13.33%) positive results for anti-reticulin antibodies IgA and IgG , 3(10%) positive results for anti-endomysial antibodies IgA and IgG . There were 4 pos

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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)
Uric Acid as a Natural Scavenger of Peroxynitrite in a Sample of Iraqi Patients with Rheumatoid Arthritis
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Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with decreased antioxidant state .This study aim to investigate the status of oxidant/antioxidant in a sample of  Iraqi patients with RA and the role of peroxynitrite and its natural scavenger uric acid in them .This case-controlled study was conducted at Baghdad teaching hospital /Baghdad from December 2010-May 2011 . Twenty-five patients with mean age 39 years and 25 apparently healthy subject as controls with mean age 29 years were included in the study .Investigations include estimation of serum levels of nitric oxide (NO)  ,peroxynitrite (PN) , malondialdehyde (MDA)  , and uric acid (UA) .Serum PN levels were significantly elevated in RA patients a

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Publication Date
Wed Oct 16 2019
Journal Name
International Journal Of Research In Pharmaceutical Sciences
Depression, Anxiety and Stress Among a Sample of Chronic Hepatitis C Patients in AL-Najaf Province /Iraq
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Previous studies in Euro-American countries have shown that patients with chronic hepatitis C virus infection have increased levels of neuropsychiatric symptoms. While chronic hepatitis C virus infection has been reported in Arab countries such as Iraq, there is little studies about the neuropsychological burden associated with chronic hepatitis C among patients in the Arab region. The aim of the current study was to measure the prevalence and level of severity of depression, anxiety and stress among a sample of chronic hepatitis C patients in AL-Najaf province /Iraq. The current study was cross-sectional study carried out on (110) already diagnosed chronic viral hepatitis C patients who attended the Gastroenterology and Hepatology

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Publication Date
Tue Jan 01 2019
Journal Name
Current Research In Microbiology And Biotechnology
Detection of Anti-rubella virus, Cytomegalovirus and Chlamydia pneumonia antibodies in patients with type I diabetes mellitus
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Type-1 diabetes is defined as destruction of pancreatic beta cell, virus and bacteria are some environmental factor for this disease. The study included 25 patients with type-1 diabetes mellitus aged between 8 – 25 years from Baghdad hospital and 20 healthy persons as control group. Anti-rubella IgG and IgM, anti-Chlamydia pneumonia IgG and IgM were measured by ELISA technique while anti-CMV antibody were measured by immunofluorescence technique. The aim of current study was to know the trigger factor for type-1 diabetes. There were significant differences (P<0.05) between studied groups according to parameters and the results lead to suggest that Chlamydia pneumonia, CMV and rubella virus may trigger type-1 diabetes mellitus in Iraqi pat

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Publication Date
Wed Mar 24 2021
Journal Name
Indian Journal Of Forensic Medicine &amp; Toxicology
Assessing Patient Preoperatively and Role in Decreasing Risks on Patients and Preventing Post-Operative Complications for Cholecystectomy
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Background: Laparoscopic cholecystectomy has many difficulties which include port Insertion, Dissectionof the Calot’s Triangle , Grasping of the Gallbladder , Wall thickness, Adhesion and extraction of theGallbladder. Aim of the Study: To predict how difficult cholecystectomy will be from assessing the patientpreoperatively which, in turn, help in decreasing the risks on the patients and preventing post-operativecomplications. Patients and Methods: A prospective study conducted in the department of General Surgeryat Al-Ramadi Teaching Hospital for the period of nine months from 15th of May 2018 till the 15th of February2019. It included 60 patients, all of them were undergone laparoscopic cholecystectomy for Gallstone. Patientswit

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