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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 May 01 2021
Journal Name
European Journal Of General Dentistry
Assessment of Serum Interleukin-1β and Interleukin-6 Levels in Patients with Chronic Periodontitis and Coronary Heart Disease
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Abstract<p> Objective The aim of this study was to assess whether serum cytokine levels correlate with clinical periodontal parameters in health or disease.</p><p> Materials and Methods Male subjects (40–60 years) with CP (n = 30), CP + CHD (n = 30), and healthy controls (n = 20) had plaque index (PLI), gingival index (GI), bleeding on probing, probing pocket depth (PPD), and clinical attachment level (CAL) evaluated. Serum IL-1β and IL-6 levels were quantified using enzyme-linked immunosorbent assay.</p><p> Results PLI, GI, PPD, and CAL were significantly higher in patients with CP + CHD compared to those with CP. Serum levels of IL-1β and IL-6 were also si</p> ... Show More
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Publication Date
Tue Jun 01 2021
Journal Name
Gene Reports
Vitamin D receptor rs2228570 and rs1544410 genetic polymorphisms frequency in Iraqi thalassemia patients compared to other ethnic populations
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Background: The genetic polymorphisms of vitamin D receptor (VDR) have an association with thalassemia development, additionally to the environmental elements that elicited the disorder in the genetically predisposed individuals. As well, VDR functions responsible for the regulation of bone metabolism, such its part in immunity. Aim: The sitting study intended to inspect the association between thalassemia disease and the genetic polymorphisms of VDR among the Iraqi population then compared these findings to other findings of thalassemia patients in other different ethnic populations. Materials and methods: The restriction enzymes Bsm-I and Fok-I were applied to determine the genetic polymorphisms frequencies of VDR by a Polymerase Chain Re

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Publication Date
Fri Nov 21 2025
Journal Name
Plos Global Public Health
Association of socioeconomic and demographic determinants with clinical outcomes in Iraqi patients with diabetes: A cross-sectional study
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Social determinants of health (SDH) profoundly influence diabetes outcomes; nevertheless, their impact on the Iraqi diabetic population remains under researched. The objectives of this study were To investigate the relationship between particular social determinants of health (SDH) variables namely food and housing insecurity, social support, income, and education and clinical outcomes, including HbA1c levels, medication adherence, and patient satisfaction among Iraqi diabetic patients. A cross-sectional study involving 212 diabetic patients in Iraq was conducted. Participants attending a healthcare facility in Iraq filled out validated questionnaires regarding social determinants of health, medication adherence, and satisfaction. HbA1c rea

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Publication Date
Tue Dec 01 2020
Journal Name
Gulf Economist
The Bayesian Estimation in Competing Risks Analysis for Discrete Survival Data under Dynamic Methodology with Application to Dialysis Patients in Basra/ Iraq
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Survival analysis is one of the types of data analysis that describes the time period until the occurrence of an event of interest such as death or other events of importance in determining what will happen to the phenomenon studied. There may be more than one endpoint for the event, in which case it is called Competing risks. The purpose of this research is to apply the dynamic approach in the analysis of discrete survival time in order to estimate the effect of covariates over time, as well as modeling the nonlinear relationship between the covariates and the discrete hazard function through the use of the multinomial logistic model and the multivariate Cox model. For the purpose of conducting the estimation process for both the discrete

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Publication Date
Thu Jan 30 2020
Journal Name
Al-kindy College Medical Journal
A Comparison between High Ablative Versus Usual Dosages of Iodine-131 in Inducing Hypothyroidism After One Year of Therapy in Hyperthyroid Patients
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Background: Radioactive iodine-131 therapy is highly effective in treating patients with hyperthyroidism. An ablative dose is preferred by a number of endocrinologists, and, a fixed dose protocol seems to be better than a calculated dose in real practice.

Objective: To check for hypothyroidism in hyperthyroid patients one year after RAI therapy, comparing between the results of high ablative versus usual dosages of RAI-131.

 Methods:  This study included 174 hyperthyroid patients, 101 males and 73 females, divided into 2 groups, the first consisted of 162 patients given a usual fixed dose of RAI while the second consisted of 12 patients given a high fixed ablati

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Publication Date
Wed Oct 10 2018
Journal Name
Al-kindy College Medical Journal
Life style modification in the management of hypertension in a sample of hypertensive patients attending Primary Health Care centers at Baghdad city
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Background: Modifications of life style are often critically important to adequately control excising hypertension.

Objective: :to determine the source of information regarding hypertension and lifestyle modification practices in the management of hypertension in a sample of Iraqi hypertensive patients.

Type of the study: Across-sectional study.:

Methods:  The study was conducted over a period of two months during November and December 2015 at Primary Health Care center of Baghdad Al-GidedaAwaland Bab Al Mudhum primary health care centers. The sample included 219 hypertensive patients (102 females and 117males).  They were subjected to a

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Publication Date
Wed Jul 27 2022
Journal Name
International Journal Of Health Sciences
Detection of coxsackie virus B and measurement level of Tumor necrosis factor alpha in patients suffered in T1DM with coxsackie virus infection
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Objective. Infection with Coxsackie virus. This virus that damages pancreatic cells, has long been linked to the onset of insulin-dependent diabetic mellitus (IDDM). Pro-inflammatory cytokines can be produced as a result of this illness. Tumor necrosis factor-a is one of these pro-inflammatory cytokines. Materials and Methods. Blood sample were collected from 180 Iraqi participants. Ninety of them is type 1 diabetic patients and other 90 is healthy control .both groups were tested for the incidence of Coxsackie virus B IgG. So the patients groups is divided to two groups according to sero positivity of CVB-IgG .all 180 patients tested to measure of level of TNF-α. Results. The Results showed increasing in levels of TNF-α in CBV po

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Publication Date
Thu Oct 25 2018
Journal Name
Al-kindy College Medical Journal
Prevalence and risk factors for hepatitis C virus in Beta thalassemic patients attending blood diseases center in Ibn- AL -Baladi Hospital, Baghdad
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Background: Thalassemias are a group of heterogeneous genetic disorders, in which the rate of production of hemoglobin is partially or completely suppressed due to reduced rate of synthesis of α or β- chain

Objectives: to estimate the prevalence of Hepatitis C infection among B thalassemia patients attending Ibn-AL-Baladi center of blood diseases in AL-Sader city, in AL-Resafa Quarter of Baghdad and to determine the possible risk factors.

Type of the study: Cross- sectional study.

Methods: A cross sectional study conducted on B Thalassemia patients attending the blood diseases center in Ibn-AL-Baladi hospital during the period from 1st

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Publication Date
Thu Jun 01 2017
Journal Name
The Journal Of Immunology
Definition of the Nature and Hapten Threshold of the β-Lactam Antigen Required for T Cell Activation In Vitro and in Patients
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Abstract<p>Covalent modification of protein by drugs may disrupt self-tolerance, leading to lymphocyte activation. Until now, determination of the threshold required for this process has not been possible. Therefore, we performed quantitative mass spectrometric analyses to define the epitopes formed in tolerant and hypersensitive patients taking the β-lactam antibiotic piperacillin and the threshold required for T cell activation. A hydrolyzed piperacillin hapten was detected on four lysine residues of human serum albumin (HSA) isolated from tolerant patients. The level of modified Lys541 ranged from 2.6 to 4.8%. Analysis of plasma from hypersensitive patients revealed the same pattern and leve</p> ... Show More
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Publication Date
Mon Feb 28 2022
Journal Name
Journal Of Educational And Psychological Researches
Social Support and Its Relationship to Psychological Rigidity in a Sample of Breast Cancer Patients In the Ramallah and Al-Bireh Governorate
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This study aims to identify the impact of social support on breast cancer patients’ psychological rigidity using a sample in Ramallah and al-Bireh. A descriptive correlative approach was adopted to fulfill the goals of the study and a questionnaire consisted of two criteria: social support and psychological rigidity, which was adopted as a tool for data collection for the study. In order to achieve the goals of the study, the researcher selected a convenient sample that consisted of 123 female breast cancer patients in Ramallah and al-Bireh. This sample represented 50% of the original patient population. The study showed that the average estimated percentage of social support and psychological rigidity for women with breast cancer, in

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