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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 Dec 02 2025
Journal Name
Journal Of Baghdad College Of Dentistry
The study of tempromandibular joint disorders and anti-cyclic citrullinated peptide antibodies in serum and saliva of patients with rheumatoid arthritis
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Background: Rheumatoid arthritis is an autoimmune disease that affects mainly the synovial membranes and articular structures and is characterized by chronic, systemic inflammation involving multiple joints.Being a synovial joint, the Temporomandibular Joint is subject to the same disorders affecting other synovial joints, including RA.Beside it was considered as a specific serological marker for diagnosing RA disease ,antibodies to cyclic citrullinated peptide have proven to be associated with joints destruction, though; it may play a potential role in the prediction of the disease severity. Materials and Methods: Sixty nine individuals (69) were enrolled in this study, forty nine (49) were patients diagnosed with Rheumatoid Arthritis, a

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Publication Date
Sun Dec 02 2012
Journal Name
Baghdad Science Journal
The Relation of IGF-1 and Insulin Resistance in a Sample of Iraqi Obese Type 2 Diabetic Patients with Macrovascular Disease
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Type 2 diabetes mellitus(T2DM) is a metabolic disease that is associated with an increased risk for atherosclerosis by 2-4 folds than in non- diabetics. In general population, low IGF-1 has been associated with higher prevalence of cardiovascular disease and mortality .This study aims to find out the relationship between IGF-1 level and other biochemical markers such as Homeostasis Model Assessment insulin resistance(HOMAIR) and Body Mass Index(BMI) in type 2 diabetic patients . This study includes (82) patients (40 females and 42 males) with age range (40-75) years,(34) non obese diabetic patients and (48) obese diabetic patients. The non obese individuals considered

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Publication Date
Wed Sep 02 2020
Journal Name
International Journal Of Pharmaceutical Research
A Study of Anti-Fungal Activity for Some Antibiotics Against Aspergillus spp. and Candida spp. in Iraqi patients with Diabetes Mellitus
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Publication Date
Sun Jan 01 2023
Journal Name
The Egyptian Journal Of Hospital Medicine
Evaluation of Interleukin-18 Serum Concentration and Gene Polymorphism (Rs1946518) in A Sample of Type-2 Diabetes Mellitus Patients from Iraq.
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Background Type two diabetes (T2DM) is characterized by insufficient insulin production and secretion. Additionally, the body develops insulin resistance which affects 90–95% of diabetics. Complex cytokines, receptors, genetic pathways, and the immune system are involved in T2DM. Interleukin-18 (IL-18) is one of the inflammatory cytokines associated with Type 2 diabetes. Environmental and genetic variables, including genetic polymorphisms, can increase T2DM risk and its consequences. Single nucleotide gene polymorphisms (SNPs) are important risk factors for diabetes that can be used to find the disease early and treat it better. Objective This study aimed to determine the levels of IL-18 in the serum of Iraqi patients with Type 2 diabetes

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Publication Date
Mon Oct 01 2018
Journal Name
Journal Of Economics And Administrative Sciences
Comparison of Beran estimator using Nadaraya-Waston and Prestley-chao weights in estimating the conditional survival function of breast cancer patients
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This study includes the application of non-parametric methods in estimating the conditional survival function of the Beran method using both the Nadaraya-Waston and the Priestley-chao weights and using data for Interval censored and Right censored of breast cancer and two types of treatment, Chemotherapy and radiation therapy Considering age is continuous variable, through using (MATLAB)  use of the (MSE) To compare weights The results showed a superior weight (Nadaraya-Waston) in estimating the survival function and condition of Both for chemotherapy and radiation therapy.

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Publication Date
Wed Jan 01 2020
Journal Name
Plant Archives
INVESTIGATION OFsHLA-GAND IT’S RECEPTOR (LILRB4) IN IRAQI PATIENTS INFECTED WITH L. INFANTUMAND THEIR EFFECTS ON THE LEVEL OF IL-12
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Visceral leishmaniasis(VL) or kala-azar is one of the world most neglected tropical diseases in mortality and fourth in morbidity, rK39 dipstick was used to diagnose the suspected infected patients as easiest and rapid technique for VL diagnostic, the disease out-coming required to the differentiation of cell mediated immunity either T-helper 1(Th-1) or (Th-2). One of main pointers that may be considered as one of immune evasion strategy in the host-parasite interplay is HLA-G level alteration. HLA-G Known as a special proteins (non-classical HLA class I) molecules which can suppress the immune system by T-cell functions impaired in the aid with target receptors as LILRB4. The development of the cell mediated immunity initiated with Interle

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Publication Date
Sun Sep 27 2020
Journal Name
Iraqi National Journal Of Nursing Specialties
Effectiveness of an Instructional Program Concerning Healthy Lifestyle on Patients’ Attitudes after Percutaneous Coronary Intervention at Cardiac Centers in Baghdad City
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Abstract:

Objective: The study’s aim to evaluate the effectiveness of instructional program about healthy lifestyle on patients’ attitudes after undergoing percutaneous coronary intervention.

Methodology: Quasi-experimental design/ has been utilized for the current study starting from December 2018 to March 2020 to achieve the objectives of the study. Non-probability (purposive) sample of 60 patients was divided into intervention and control groups. Data were analyzed by the application of descriptive and inferential statistical methods.

Results: findings reported that before intervention both study and control groups demonstrated low total mean of score relat

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Publication Date
Mon Jul 24 2023
Journal Name
Research Journal Of Pharmacy And Technology
Comparison of the effects of Methotrexate and Etanercept on RANKL and OPG as Bone Metabolism Biomarkers in patients with Rheumatoid Arthritis
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Rheumatoid arthritis is an autoimmune diseasecharacterized by chronic inflammationthat affects joints and cartilage. Bone complications such asRA-relatedosteoporosis are one of the most extra-articular manifestations. Many inflammatory mediators are released during RA disease pathophysiology; these mediators stimulate osteoclast genesis of bone by direct effects on RANKL and OPG. The study aimedto measure RANKL, OPG in RA patients treated with Etanercept only and other groups treated with Methotrexate onlyat baseline and after three months to evaluate bone state. An observational case-control prospective study was done on 30 RA patients who received MTX, 30 RA patients who received ETN, and 30 healthy,age-matched control groups. The

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Publication Date
Sun Jan 01 2023
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Effect of Radioactive Iodine Therapy on Interleukin-2 (IL-2), IL-17 and Physiological Parameters in Iraqi Patients with Graves’ Disease
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Publication Date
Thu Mar 30 2017
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
The Effect of Long Term use of Glibenclamide on Serum and Urinary Sodium and Potassium Level in Type 2 DM Patients
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         Long-term use of sulfonylureas including chlorpropamide, is known to potentiate the antidiuretic action of arginine vasopressin (AVP), predisposing to hyponatremia.The present study was designed to evaluate the effect of long term use of glibenclamide on serum and urinary levels of sodium and potassium in Type 2 DM patients in Iraqi DM centers. Ninety eight patients with Type 2 DM who were maintained on different doses of glibenclamide for at least 1 year, attending the centre for Diabetes and Endocrinology in Al-Rusafa, Baghdad, were enrolled in the study, in addition to 15 normal healthy subjects. Patients were allocated into three groups according to the dose of glibenc

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