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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
Tue Oct 01 2024
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Assessment &lt;b&gt;&lt;/b&gt;of Serum P53 Protein Level in Adult Patients with Acute Myeloid Leukemia in Correlation with Response to Treatment
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Background: Acute myeloid leukemia (AML) is an adult leukemia characterized by rapid proliferation of undifferentiated myeloid precursors, leading to bone marrow (BM) failure and impaired erythropoiesis. The p53 tumor suppressor protein regulates cell division and inhibits tumor development by preventing cell proliferation of altered or damaged DNA. It orchestrates various cellular reactions, including cell cycle arrest, DNA repair, and antioxidant properties. Objectives: To investigate the relationship of P53 serum level with hematological findings, remission, and survival status in de novo AML patients. Methods: This is a cross-sectional study that enrolled 63 newly diagnosed de novo AML patients, and 15 sex- and age-matched healt

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Publication Date
Mon Mar 27 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Evaluation of the Clinical use of Metformin or Pioglitazone in Combination with Meloxicam in Patients with Knee Osteoarthritis; using Knee Injury and Osteoarthritis outcome Score
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Osteoarthritis is the most prevalent arthritic disease and a leading cause of disability. The pathogenesis of osteoarthritis involves multiple etiologies, including variable degree of synovial inflammation. Metformin and pioglitazone could potentially reduce the levels and activity of inflammatory mediators. This may consider as a new therapeutic approach added to the current used drugs in an attempt to decrease the pain, inflammation, and improve daily activity and quality of life in patients with knee osteoarthritis.

This study designed to evaluate the clinical utility of using metformin or pioglitazone as anti-inflammatory agents in combination with non-steroidal anti-inflammatory drugs (NSAID) of selective type of cyclooxygen

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Publication Date
Fri Nov 02 2018
Journal Name
Iraqi National Journal Of Nursing Specialties
Validity of Testicular Biopsy Among Azoospermic Patients Prior to Intracytoplasmic Sperm Injection
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Objective: To evaluate the clinical significance of open diagnostic testicular biopsy as prognostic predictor of
successful sperm retrieval among azoospermic infertile patients.
Design: Prospective study.
Setting: Infertility clinic and assisted reproduction unit at the institute of embryo research and infertility
treatment, Baghdad University.
Patients: Sixty infertile azoospermic patients.
Intervention: Pieces of testicular tissue taking during open diagnostic multiple bilateral testicular biopsies was
prepared for histological examination and grouped according to well-defined histopathological patterns.
Measurement of testicular size and serum reproductive hormones (FSH, LH, Testosterone, and PRL) were done

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Publication Date
Wed Mar 10 2021
Journal Name
Baghdad Science Journal
Serum Protein Profile Of Iraqi Hydatidosis Patients with Different Sites of Infection
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Blood samples of One hundred and twenty patients from different hospitals in Baghdad infected with hydatidosis in different sites of the body (Liver, Lung, multiorgans and kidney) were collected for this study. On the other hand, 30 healthy individuals were included as a control group. This study was conducted to evaluate the effect of this disease on the serum protein profile of the patients using electrophoresis. The results revealed four different protein banding patterns with difference in number of bands and their molecular weights in comparison to the control group, and these differences depended on the site of infection. However the data showed a presence of the same band in all patients with different site of infection.

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Crossref
Publication Date
Tue Dec 11 2018
Journal Name
Iraqi National Journal Of Nursing Specialties
Effectiveness of Preoperative Psycho-educational Program on Stress of Cardiac Surgery Patients
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Objective: The study aimed to determine the effectiveness of preoperative psycho - education al
program on cardiac surgery patients information and their level of stress. And find out the differences
in the Psycho educational
program with regard to patients demographic characteristics such as age and gender.
Methodology Aquazi-experimental study was carried out to determine the effectiveness of
preoperative education program on stress for cardiac surgery patients in Baghdad city from the 28th of
March, 2010 , to 19th of September ,2011.
The preoperative psycho - educational program, as well as the questionnaire was constructed as a tool of
data collection for the purpose of the study. Purposive (non probability) s

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Publication Date
Fri Sep 01 2017
Journal Name
Gulf Journal Of Oncology
Clinical and Pathological Characteristics of Triple Positive Breast Cancer among Iraqi Patients
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Background: Breast cancer is the most common malignancy affecting the Iraqi population and the leading cause of cancer related mortality among Iraqi women. It has been well documented that prognosis of patients depends largely upon the hormone receptor contents and HER-2 over expression of their neoplasm. Recent studies suggest that Triple Positive (TP) tumors, bearing the three markers, tend to exhibit a relatively favorable clinical behavior in which overtreatment is not recommended. Aim: To document the different frequencies of ER/PR/HER2 breast cancer molecular subtypes focusing on the Triple Positive pattern; correlating those with the corresponding clinico-pathological characteristics among a sample of Iraqi patients diagnosed with th

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Publication Date
Wed Jan 30 2013
Journal Name
Al-kindy College Medical Journal
Wilson's Disease; Clinical Presentations among Patients Attending Gastroenterology Clinic/ Baghdad Teaching Hospital
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Background:Wilson’s disease (WD) is an inherited
disorder of copper metabolism that is characterized
by tremendous variation in the clinical presentation.
Objective: To assess demographic distribution,
clinical presentations, diagnostic evaluation, and any
association between clinical presentations and other
studied variables of a sample of Iraqi patients with
WD.
Methods: A descriptive cross sectional study with
analytic elements was conducted during 2011, from
the 1st of February till the 10th of June. The sampling
method was a convenient non-random one, carried
out through consecutive pooling of registered WD
patients. A questionnaire-form paper had been
developed for the process of data col

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Publication Date
Thu May 05 2022
Journal Name
Al-kindy College Medical Journal
Assessment of Lipid Profile among Sudanese patients with Type 2 Diabetes Mellitus
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Background: Diabetes mellitus is a major health issue that is one of the leading causes of cardiovascular disease. Recent studies have found a link between uncontrolled diabetes and cardiovascular disease, with dyslipidaemia predicting glycated-hemoglobin (HbA1c), which could be a major contributor to type 2 diabetes complications and etiology.

Objectives: The objective of present study was estimate lipid profiles among control and uncontrolled type 2 diabetic patients.

Subjects and Methods: Analytical case control based study, One hundred twenty participate were included in study, 70 patients with DM  as case group  refer to Abuagala Center and difference follow up diabetic center  and 50 non diabetic subjects taken as

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Publication Date
Wed Aug 02 2023
Journal Name
Bionatura
Comparative Study of IgG Between Iraqi Covid-19 Patients and Vaccinated Individuals
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COVID-19 is a coronavirus disease caused by the severe acute respiratory syndrome. According to the World Health Organization (WHO), coronavirus-2 (SARS-CoV-2) was responsible for 87,747,940 recorded infections and 1,891,352 confirmed deaths as of January 9, 2021. Antibodies that target the Sprotein are efficient in neutralizing the virus. Methodology: 180 samples were collected from clinical sources (Blood and Nasopharyngeal swabs) and from different ages and genders at diverse hospitals in Baghdad / IRAQ between November 5, 2021, to January 20, 2022. All samples were confirmed infected with COVID-19 disease by RT-PCR technique. Haematology analysis and blood group were done for all samples, and Enzyme-Linked Immunosorbent Assay used an Ig

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Scopus
Publication Date
Tue Dec 31 2024
Journal Name
Asia Pacific Journal Of Molecular Biology And Biotechnology
Molecular typing of multidrug resistant Klebsiella pneumoniae recovered from Iraqi burned patients
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Klebsiella pneumoniae causes lethal nosocomial infections, mostly affecting patients with severe burns. More than 80% of its isolates have shown resistance to routinely used antibiotics in parallel with increased infection rates. The study aimed to determine the molecular typing and genetic relatedness of K. pneumoniae. Therefore, 20 multidrug resistant (MDR) K. pneumoniae already isolated from infected burned wounds in two major hospitals of Al-Kut city east Iraq were subjected to genotyping analysis. The random amplified polymorphic DNA (RAPD)-based polymerase chain reaction (PCR) technique was used along with three oligonucleotide primers (P13, OPX-04, and OPY-01). The amplicons’ patterns of the electrophoresis-gel were analyzed by the

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