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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
Thu Apr 01 2021
Journal Name
Biochem. Cell. Arch
Biological Therapy for Patients With Rheumatoid Arthritis and Its Effect on Periodontal and Immunological Parameters
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Rheumatoid arthritis and periodontitis use analogous effector destructive procedures, in that the inflammatory cells and pro-inflammatory cytokines that drive chronic bone erosion in RA and chronic periodontal destruction in Periodontitis are alike. Periodontitis (PD) has appeared as a hazard factor in a number of health situations as rheumatoid arthritis (RA). To determine the effect of anti-tumor necrosis factor alpha biological treatment (methotrexate and Enbrel or infliximab) on periodontal status of patients having rheumatoid arthritis with periodontitis in comparison to those having periodontitis without rheumatoid arthritis and control healthy subjects and to determine the serum levels of anti-cyclic citrullinated peptide (ACCP) in t

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Publication Date
Wed Nov 01 2023
Journal Name
Al-rafidain Journal Of Medical Sciences ( Issn 2789-3219 )
The Impact of Implementing a Pharmacist-led Deprescribing Program on Medication Adherence among Hemodialysis Patients
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Background: One way to target polypharmacy and inappropriate medication in hemodialysis (HD) patients is with medication deprescribing. Objective: To assess the impact of implementing a pharmacist-led deprescribing program on medication adherence among HD patients. Method: A prospective interventional, one-group pretest-posttest-only design study was conducted at a hemodialysis center in Wasit Governorate, Iraq. Medication reconciliation followed by medication review based on the deprescribing program was done for all eligible patients, and the patients were monitored for three months for any possible complications. Results: Two hundred and seventy patients were screened for eligibility. Only one hundred and eighteen were enrolled i

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Publication Date
Wed Nov 07 2018
Journal Name
Iraqi National Journal Of Nursing Specialties
Study of some risk factors and C - reactive protein levels among patients with cardiovascular diseases
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Objective : To study the effect of some risk factors like age, smoking and Diabetes mellitus (DM) among patients with
certain cardiovascular diseases (Angina pectoris and Myocardial infarction), in addition to the assessment of the Creactive
protein (CRP) in the sera of those patients.
Methodology: The study was carried out on (100) subjects who were hospitalized in the Iraqi Center of heart Diseases
in Baghdad city and were suffering from Myocardial InfarcƟon (MI) (16) and Angina Pectoris (AP) (79) or from both (5)
over a period from September 2009 to June 2010. The results of paƟents were compared with those of (30) healthy
and age-matched individuals as a control group. Data were obtained from patients who were alr

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Publication Date
Sun Mar 01 2020
Journal Name
Journal Of Accounting And Financial Studies ( Jafs )
Implement some basic health accreditation standards Issued by the Health Care Accreditation Council (HCAC) for auditing the Performance of Hospitals: Applied research at the Education Children Protection Hospital
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The health care provided by health institutions and all kinds suffers from many problems, and since the health services provided are related to human life, it is necessary to shed light on this activity and identify the causes of these problems. This research aims to Definition of health institutions (hospitals) Performance audit of these institutions according to the latest indicators, which are the standards of health accreditation for hospitals, specifically the basic standards issued by the Health Care Accreditation Council (HCAC) to reach the level of performance and Knowledge of Constraints that lead to in an acceptable manner consistent with the approved standards. In theoretical and practical study, a number of conclusions were r

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Publication Date
Tue Oct 01 2013
Journal Name
Journal Of Economics And Administrative Sciences
Efficiency of Human Resources Information System and Its Impact on The Level Effectiveness of Employees Performance Appraisal System / Practical Research on Ministry of Higher Education and Scientific Research
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Abstract

The research aims to determine the role of the efficiency of Human Resources Information System in the effectiveness of Employees Performance Appraisal System in the Ministry of Higher Education and Scientific Research / Center for the ministry, it was touching the researchers need the ministry to devise methods that employ outputs Human Resources Information System in the organization surveyed for the development of methods and levels of process evaluate the performance of its employees, in order to identify the extent of the role played by human resources information system in the process of assessing the performance of employees, we raised the question of the President as follows:

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Publication Date
Wed Jan 01 2020
Journal Name
International Journal Of Innovation, Creativity And Change (ijicc)
The relationship between conceptual knowledge and procedural knowledge among students of the mathematics department at the faculty of education for pure sciences/IBn Al-Haitham, university of Baghdad
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Publication Date
Tue Sep 08 2020
Journal Name
Al-kindy College Medical Journal
Comparison between the Use of bupivacaine 0.5%alone and bupivacaine 0.5% with nefopam 20mg in sciatic n block ( popliteal approach) and femoral n block in patients undergoing below knee surgery
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Objective : Sciatic nerve block (popliteal approach) and femoral N block is a new technique other than general anesthesia in below knee surgery because it provides adequate muscle relaxation, with good intraoperative and post-operative analgesia. Nefopam is non opioid, non-respiratory depressant and non-sedative was mixed with local anesthetics drug to study the effects. This study was done to compare the onset and duration of sensory and onset time and duration of action of motor block following administration of either bupivacaine alone with administration of bupivacaine and Nefopam in patients undergoing below knee lower limb surgeries under ultrasound guided regional anesthesia.
Methods: 100 patients with American society of anest

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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)
Evaluation of the Relation between Asthma, Obesity and Leptin Level in Iraqi Asthmatic Patients and the Main Risk Factors that are Associated with Leptin Level
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This study tries to clear the correlation and association between asthma, obesity and leptin levels. Also it will work to indicate the main risk factors which play role in the elevation of leptin level within asthmatic patients.  This is a case control study conducted on (38) asthmatic patients and (20) healthy control who were closely similar by age, gender and BMI. The main statistical tests used were student t test, linear regression test and correlation test. Significance was set at P < 0.05. Sampling method used for this study was convenience sampling method.  The main results of this study show a significant association and positive correlation between age (old age  â‰¥ 40 ye

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Publication Date
Thu Mar 02 2023
Journal Name
East European Journal Of Physics
Evaluation of the Influence of Body Mass Index and Signal-to-Noise Ratio on the PET/CT Image Quality in Iraqi Patients with Liver Cancer
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Image quality has been estimated and predicted using the signal to noise ratio (SNR). The purpose of this study is to investigate the relationships between body mass index (BMI) and SNR measurements in PET imaging using patient studies with liver cancer. Three groups of 59 patients (24 males and 35 females) were divided according to BMI. After intravenous injection of 0.1 mCi of 18F-FDG per kilogram of body weight, PET emission scans were acquired for (1, 1.5, and 3) min/bed position according to the weight of patient. Because liver is an organ of homogenous metabolism, five region of interest (ROI) were made at the same location, five successive slices of the PET/CT scans to determine the mean uptake (signal) values and its standard deviat

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Publication Date
Sun Oct 01 2023
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Immunohistochemical study of the expressed cluster differentiation markers proteins type 20 and 56 in breast tissues from a group of Iraqi patients with breast cancers
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