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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
Wed Sep 14 2016
Journal Name
Journal Of Baghdad College Of Dentistry
Evaluation of Systemic C-reactive Protein as a Systemic Inflammatory Marker in the Blood for Patients Undergoing Minor Oral Surgical Procedures
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Background: C-reactive protein (CRP) is an acute phase protein that its plasma levels increase after trauma or surgery so it is used as an indicator for the level of inflammation after surgery. The objective of this study is to investigate pre- and post-operative levels of CRP in three types of oral surgical interventions (Apicoectomy, Impaction, and Impacted teeth exposure). Materials and Methods: A total number of (48) healthy individuals aged (20-60) years who needed oral surgical intervention for either (removal of impacted third molars, exposure of an impacted canine, or Apicoectomy). A 4ml venous blood was obtained from each patient at two occasions (pre-operatively at the day of operation and post-operatively after 48 hours), then ce

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Publication Date
Mon Jul 01 2024
Journal Name
Journal Of The Faculty Of Medicine Baghdad
The Burden of Chronic Obstructive Pulmonary Disease COPD in Stable Patients and its Association with Inflammatory Biomarkers and Body Mass Index
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Background: Chronic obstructive pulmonary disease (COPD) is a progressive airflow limitation that is preventable but not curable. It is associated with persistent symptoms that cause a considerable burden on individual productivity at work, and daily activities, and reduced quality of life, also burdening the healthcare system and society. Objectives: The study aims to measure the burden of COPD on patients in terms of daily activities and work productivity. It also seeks to investigate some inflammatory biomarkers' levels and their correlation with selected outcomes. Patients and Methods: A cross-sectional study on 120 stable COPD patients who were diagnosed and treated according to the GOLD guidelines at Kirkuk General Hospital's

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Publication Date
Wed Jan 29 2020
Journal Name
Advances In Rheumatology
Neutrophil/lymphocyte and platelet/lymphocyte ratios as potential markers of disease activity in patients with Ankylosing spondylitis: a case-control study
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Abstract<sec> <title>Background

The neutrophil/ lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have the potential to be inflammatory markers that reflect the activity of many inflammatory diseases. The aim of this study was to evaluate the NLR and PLR as potential markers of disease activity in patients with ankylosing spondylitis.

Methods

The study involved 132 patients with ankylosing spondylitis and 81 healthy controls matched in terms of age and gender. Their sociodemographic data, disease activity scores using the Bath Ankylosing

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Publication Date
Sun Dec 30 2012
Journal Name
Al-kindy College Medical Journal
The Detection of Silent Celiac Disease In patients With Type 1 Diabetes Mellitus by the use of Anti Tissue Transglutaminase Antibodies
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Objective: Detection the presumptive prevalence of silent celiac disease in patients with type 1 diabetes mellitus with determination of which gender more likely to be affected.
Methods: One hundred twenty asymptomatic patients [75 male , 45 female] with type 1 diabetes mellitus with mean age ± SD of 11.25 ± 2.85 year where included in the study . All subjects were serologically screened for the presence of anti-tissue transglutaminase IgA antibodies (anti-tTG antibodies) by Enzyme-Linked Immunosorbent Assay (ELISA) & total IgA was also measured for all using radial immunodiffusion plate . Anti-tissue transglutaminase IgG was selectively done for patients who were expressing negative anti-tissue transglutaminase IgA with low tot

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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)
Efficacy of Combination of Meropenem with Gentamicin, and Amikacin against Resistant E. coli Isolated from Patients with UTIs: in vitro Study
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         Seventy five E. coli isolates were collected from urine of patients with urinary tract infections in AL-Kadhimia and AL-Yarmook teaching hospitals in Baghdad for a period between 22/11/2009 to 15/3/2010,  from these samples twenty five isolates were selected according to their pattern of the highest resistance as these showing multi-drug resistances and tested to specify their minimum inhibitory concentration for (meropenem, gentamicin and amikacin), meropenem was found having the lowest MIC comparing with others. This study also includes in vitro effects of various combinations of three types of antimicrobials (meropenem, gentamicin and amikacin) against twenty five E. c

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Publication Date
Sat Dec 24 2022
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Occurrence of Quinolone-Resistance Genes in Ciprofloxacin-Resistant Salmonella Enterica Serotype Typhi Isolated form Blood Sample of Patients with Typhoid Fever
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Salmonella is approved as a common foodborne pathogen, causing major health problems throughout the world particularly in low‐ and middle‐income countries. Low-level fluoroquinolone resistance is conferred by both chromosomal and plasmid-encoded resistance, this research was carried out look into the occurrence rate of qnrA,qnrB and qnrS genes  in  Salmonella enterica serotype Typhi Cipr  ofloxacin-resistant insulate from blood samples of patients with typhoid fever. Fifteen Salmonella enterica serotype Typhi isolated previously from patients with typhoid fever were included in this study. All bacterial isolates were confirmed to have ciprofloxacin

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Publication Date
Sun Jun 05 2016
Journal Name
Baghdad Science Journal
Level and Statistical Distribution of Thyroid Peroxidase and Thyroid Hormones in Iraqi patients with Type1 Diabetes Mellitus at Al-Karkh Side
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Type 1 diabetes mellitus (T1DM) is an autoimmune disease frequently associated with autoimmune thyroid disease (AITD). The study is conducted at the Specialized Center for Endocrinology and Diabetes-Baghdad at Al-karkh side, during December 2013 up to April 2014. In this study, we investigate the prevalence of anti-thyroid peroxidase (anti-TPO) antibody in(80) type1 diabetic patients with (AITD) and (30) healthy controls .Blood samples are taken for investigation of thyroid tests by using Vitek Immunodiagnstic Assay System (VIDAS).Enzeme Linked Immunosorbent Assay (ELISA) is used to detect anti-thyroid antibody(anti-TPO). The results show that age, gender and BMI (body mass index) are similar in both groups, p>0.05. Among 80 type1 diabetic

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Publication Date
Fri Jan 01 2021
Journal Name
Brazilian Dental Science
Assessing the level and diagnostic accuracy of osteopontin and oral health status in periodontitis patients with/without Type-2 Diabetes Mellitus
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Publication Date
Thu Oct 18 2018
Journal Name
Iraqi Journal Of Market Research And Consumer Protection
STUDY OF THE TEMPORAL EFFECT OF THE LEVEL OF THE CREATINE KINASE ENZYME CK-MB AND SOME BIOMARKERS IN PATIENTS WITH MYOCARDIAL INFARCTION AND HEART FAILURE IN RAMADI CITY: STUDY OF THE TEMPORAL EFFECT OF THE LEVEL OF THE CREATINE KINASE ENZYME CK-MB AND SOME BIOMARKERS IN PATIENTS WITH MYOCARDIAL INFARCTION AND HEART FAILURE IN RAMADI CITY
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The current study is designed to achieve the goal of early detection of heart disease because it is the main risk of death. Some biomarkers were measured as well as the percentage of the effect of certain risk factors in people with myocardial infarction and heart failure. The study included 40 serum samples from people with heart disease. The effectiveness of the creatine kinase (CK-MB), as well as its temporal and albumin effects, as well as sodium ions in people with myocardial infarction and heart failure, were compared with the control group. as shown below:

-The first group consisted of 25 blood samples from people with myocardial infarction and 15 serum samples from people with heart failure. Blood

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Publication Date
Sun Aug 01 2021
Journal Name
Turkish Journal Of Physiotherapy And Rehabilitation
BUILDING AND RATIONING SCALE MANAGEMENT CONSTRAINTS OF E-LEARNING FROM THE PERSPECTIVE OF TEACHING THE FACULTY OF PHYSICAL EDUCATION AND SPORTS SCIENCE UNIVERSITY OF BAGHDAD
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