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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 01 2015
Journal Name
Baghdad Science Journal
Evaluation of Electrolytes Disturbances in Iraqi Chronic Myeloid Leukemia Patients treated with Nilotinib with Monitoring of Response by FISH Study
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Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by the presence Philadelphia chromosome (Ph) which was created by a reciprocal translocation between chromosomes 9 and 22 (t [9;22] [q34;q11]. The approval of the 2nd generation TKI ( Nilotinib) takes the treatment of CML patients into new erea with more efficiency and mild to moderate adverse effects. This study was aimed at evaluation of molecular cytogenetic response by (FISH) for Nilotinib in Iraqi patients with assessment for electrolytes disturbances of Nilotinb by measuring a panel of electrolyte (Na+, K+, Ca++, PO4--- and Mg++) , where thirty Iraqi patients with CML who have resistance or no response to Imatinib treatment, attending to Baghdad Teaching Ho

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Publication Date
Mon Jan 01 2024
Journal Name
Oncology And Radiotherapy
Comparting study of cytokeratin 18 fragment M65 with CA19-9 and CEA as a biomarker in Iraqi colon cancer patients
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Publication Date
Thu Oct 20 2022
Journal Name
Ibn Al-haitham Journal For Pure And Applied Sciences
Correlation Study of Retinol Binding Protein4, Vitamin A with Liver Function Enzymes in Iraqi Fracture Patients with and without DM2
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A fracture is a damage to bone tissue that causes damage to the tissue surrounding the bone and may penetrate the skin. Subjects and methods: the present study included (80) fractured Iraqi patients (and 40) patients with DM2 and (40) without DM2 and compared them with (40) healthy control. Patients and control are matched in age. This study showed a significant increase in retinol-binding protein 4 (RBP4) and a considerable decrease in Vit .A GPT and GOT in fracture patients with and without DM2. In addition, there was a significant negative correlation between RBP4 with (GPT and GOT) in fracture patients with DM2 and a significant positive correlation between RBP4 with (GPT and GOT) in fracture patients without DM2.       

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Publication Date
Mon Nov 02 2020
Journal Name
International Journal Of Pharmaceutical Research
Serum Afamin As A Novel Biomarker for Non-Alcoholic Fatty Liver Disease as A Complication of Hypothyroidism in Iraqi Patients.
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Publication Date
Sat Dec 31 2022
Journal Name
Al-kindy College Medical Journal
Assessment of Serum Level of Protein Carbonyl as a Marker of Protein Oxidation in Patients with Type 2 Diabetes Mellitus
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Background: Diabetes mellitus is a chronic disease with an increasing prevalence worldwide and characterized by an increase in oxidative stress and inflammation. The most important factor that is responsible for oxidative stress and production of reactive oxygen species (ROS) is hyperglycemia. The major targets of ROS are proteins. The most common and widely used biomarker of severe oxidative protein damage is protein carbonyl content.

The study was designed to assess the serum level of protein carbonyl as a marker of protein oxidation in patients with type 2 diabetes mellitus and to evaluate the effect of age, body weight, waist circumference, diabetic control and disease duration on the level

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Publication Date
Wed Jan 12 2022
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn: 1683 - 3597 , E-issn : 2521 - 3512)
A Pharmacoeconomics Study for Anticoagulants used for Hospitalized COVID-19 Patients in Al-Najaf Al-Ashraf city –Iraq(Conference Paper )#
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Abstract Background: The novel coronavirus 2 (SARS?CoV?2) pandemic is a pulmonary disease, which leads to cardiac, hematologic, and renal complications. Anticoagulants are used for COVID-19 infected patients because the infection increases the risk of thrombosis. The world health organization (WHO), recommend prophylaxis dose of anticoagulants: (Enoxaparin or unfractionated Heparin for hospitalized patients with COVID-19 disease. This has created an urgent need to identify effective medications for COVID-19 prevention and treatment. The value of COVID-19 treatments is affected by cost-effectiveness analysis (CEA) to inform relative value and how to best maximize social welfare through evidence-based pricing decisions. O

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Publication Date
Thu Feb 16 2023
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Cost-effectiveness Analysis of Reference Infliximab (Remicade) Compared to its Biosimilar (Remsima) in Iraqi Patients with Rheumatoid Arthritis (Conference Paper )#
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The study objective was to conduct Pharmacoeconomics study (cost-effective analysis) between infliximab reference (Remicade) and its biosimilar (Remsima) in patients with rheumatoid arthritis (RA) in Iraqi hospitals.

This is a retrospective multicenter pharmacoeconomic analysis conducted at two large teaching governmental hospitals in Baghdad, Iraq which provided infliximab to patients with RA. Data were collected from patient’s medical records and face-to-face interviews with the patients from December 2021 to April 2022.

The study included 57 patients with rheumatoid arthritis (RA).  The patients were categorized into two groups according to the type of infliximab they received over 30 weeks: 27 patients received

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Publication Date
Sun Sep 27 2020
Journal Name
Iraqi National Journal Of Nursing Specialties
Effectiveness of an Educational Program on Patients’ Knowledge Concerning care of Vascular Access of Hemodialysis in Al-Muthana Teaching Hospitals
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Objectives:  The study aims to identify the effects of an educational program on patients’ knowledge about vascular access care and to find out the relationship between patients knowledge scores and their selected demographic variable.                                                                                  &

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Publication Date
Sun Jun 09 2019
Journal Name
Al-kindy College Medical Journal
The Prevalence of Acetabular Retroversion among Adult Patients Presenting with Hip Pain in Orthopedic Clinic of Al-Kindy Teaching Hospital
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Background: Acetabular retroversion has been proposed to contribute to the development of pain and osteoarthritis of the hip. Conventional anteroposterir (AP) pelvic radiographs may represent a reliable, easily available diagnostic modality.

Objective: To obtained a reproducible technique allowing the anterior and posterior acetabular rims to be visible for assessment

Method: This is a cross-sectional study conducted from December 2015 to March 2017 targeting patients with hip pain in orthopedic clinic of Al-Kindy teaching hospital. The study sample consisted of 100 patients with hip pain who were investigated with Antroposterior pelvic plain x-ray, which was done for all

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Publication Date
Sun Apr 30 2023
Journal Name
Al-kindy College Medical Journal
Persistent Intraocular Pressure Elevation after Silicon Oil Removal in Patients with Post-Pars Plana Vitrectomy: IOP Level After SO Removal
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Background: It is well-known that silicon oil (SO) injection into the vitreous cavity after pars plana vitrectomy is usually associated with high intraocular pressure.

Objectives: To determine the influence of silicon oil (SO) removal on IOP level after pars plana vitrectomy for spontaneous rhegmatogenous retinal detachment (RRD)

Subjects and Methods: A prospective study was conducted at Ibn Al-Haitham eye teaching hospital, Baghdad- Iraq. Intraocular pressure (IOP) was measured pre and post SO removal in patients who have underwent retinal detachment surgery with SO injection of 1000 centistokes (cSt) viscosity. Baseline IOP was measured for all the patient before the SO

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