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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
Mon Jan 01 2024
Journal Name
Cytokine
Evaluation of IL-8, nitric oxide and macrophage inhibitory factor as clinical circulatory markers in patients with cutaneous leishmaniasis, before and during sodium stibogluconate treatment
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The clinical spectrum of cutaneous leishmaniasis (CL), an intracellular parasitic pathogen, ranges from a single sore healing to chronic crusty lesions with a manifestation of treatment resistance. The complicated interaction between Leishmania bodies and the early immune response, including innate and adaptive mechanisms, determines the evolution of nodules. This study examined the levels of the chemoattractant interleukin 8 (IL-8), pro-inflammatory nitric oxide (NO), and immunoregulatory macrophage inhibitory factor (MIF) in the serum of subjects recently diagnosed with cutaneous leishmaniasis, in parallel with patients being monitored during consecutive sodium stibogluconate (Pentostam) treatment. A total of 161 serum samples of newly di

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Publication Date
Thu Jan 01 2015
Journal Name
Iraqi Journal Of Biotechnology
Association among family history and some microbial infectious ( Helicobacter pylori IgG and Hepatitis B and C Virus) as Risk Factors for Atherosclerosis in Iraqi Patients
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Certain bacterial and viral infectious agents may play a role in the activation of inflammation in atherosclerosis lesions. Epidemiological studies indicate that infectious agents may predispose patients to atherosclerosis as Infections have been associated with an increased risk of this disease. Moreover, a positive antibody status has been detected against some infectious organisms associated with atherosclerotic rupture. Infectious agents found in human atheroma, which may directly cause or accelerate atherosclerosis , include many pathogens but the present study focused on Helicobacter pylori, hepatitis B virus surface antigen and C. In order to evaluate the possible association between H. pylori, HBV, and HCV infections and the risk of

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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)
Determining the Prevalence of Upper and Lower Urinary Tract Infections’ Pathogens and Their Antibiotic Susceptibility Profile for Adult Patients in Al-Diwaniya, Iraq (Conference Paper) #
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Until today, one of the leading predominant infections is Urinary tract infection (UTI). It exerts a huge burden on health systems worldwide each year. Treating UTIs empirically with antimicrobials improves morbidity rates. This study aims to assess the prevalence of UTI-associated bacteria in adult patients and to determine their antibiotic susceptibility profile. A retrospective study was conducted for adult outpatients who visited Al-Diwaniya tertiary hospitals from January 2020 till February 2022 to review their medical and lab records in addition to sociodemographic data. A total of 256 patients’ records were included of which 204 (79.7%) belong to females and 52 (20.3%) were males with an average age of 39.22±17.10 years. The pr

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Publication Date
Thu Oct 01 2020
Journal Name
Biochemical And Cellular Archives
Study on the effect of methotraxate drug on Retinol-Binding Protein 4 (RBP4), nesfatin and some trace elements in Iraqi male patients with rheumatoid arthritis
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Methotrexate (MTX) is one of the most effective medications to treat rheumatoid arthritis (RA).Aserum of 60 Iraqi male patients suffering from RA as (G1) was newly diagnosis and the same patient in G1 after taking MTX as G2 and 40 Iraqi male healthy control as G3. Nesfatin-1 (Nf-1) is belong to the adipokine family withpleiotropic effect. Nf-1 has been found in different tissues, including stomach, pancreas, bone cells, cartilage and heart. Retinol binding protein (RBP4) was known as transpoter of retinol from its storage sites in the liver to the extrahepatic tissues. Moreover, RBP4 acts as adipokine and contributes in the pathophsyology of prototypic inflammatory disease, rheumatoid arthritis (RA). The results showed a significant increas

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Scopus
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 Oct 01 2014
Journal Name
Al–bahith Al–a'alami
The electronic news bulletin of the ministry of higher education and scientific research: A study in the newspapers of: (AL-Taakhi, AL-Zaman, ALAdala,AL-Sabah and Baghdad) for period from 2nd October 2011 to 1st November 2011
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The research aims to know the reverberation of the the electronica news bulletin of the ministry of higher education and scientific research  in the newspapers of: (AL-Taakhi, AL-Zaman, ALAdala,AL-Sabah and Baghdad) for period from 2nd October 2011 to 1st November 2011 to explain its activity and advantage for the other newspapers and to show the importance which the newspapers showed for the study of the news subject in the bulletin, as well as,to show the proportional differences in which the newspapers interested in the subjects of the published news, and to reach to the results which lead us to good conclusions for the service of decision owner and open new horizons for the researchers to expanding in the s

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Publication Date
Tue Dec 02 2025
Journal Name
Al-fatih Journal
Some cognitive sense of kinesthetic and spatial relationship to the level of learning some skills in the ground dictated by hardwareResearch and descriptiveStudents on the third phase of the Faculty of Physical Education for Girls - University of Baghdad
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إن النجاح في أداء المتطلبات الفنية والخططية في أي من الألعاب ألرياضيه يستوجب امتلاك العناصر الاساسيه المتعلقة بطبيعة الاداء ونوع الفعالية الرياضية الممارسة , لذا فان اغلب الألعاب الرياضية تعتمد على مكونات ألقدره التوافقيه والادراكيه الحسيه بوصفها احد العناصر الاساسيه في المستويات العليا لما توفره من قاعدة اقتران للصفات البدنيه والحر كيه وقدرات أجهزة الجسم الوظيفية , وفقا للأسس المعتمدة في بناء مهاراته, وع

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Publication Date
Sun Jun 30 2024
Journal Name
Sports Culture
Designing and rationing of test to measure the motor compatibility for the eye and the leg for students of the Faculty of Physical Education and Sports Sciences, Samarra University
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The research aims to identify: 1-Designing a test to measure the movement compatibility of the eye and the leg for the students of the Faculty of Physical Education and Sports Sciences, Samarra University. 2-Codification (setting scores and standard levels) for the results of the motor compatibility test for the eye and the leg for students of the Faculty of Physical Education and Sports Sciences, Samarra University. The researchers reached the some following conclusions: 1-A test to measure the movement compatibility of the eye and the leg for the students of the Faculty of Physical Education and Sports Sciences. 2-There is a discrepancy in the standard levels of the research sample.

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Publication Date
Sat Dec 28 2024
Journal Name
Journal Of Physical Education
Obstacles to achieving quality field application performance from the point of view of fourth-stage female students at the College of Physical Education and Sports Sciences, University of Baghdad
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The aim of the research was to prepare a scale of obstacles to achieving quality performance, field application from the point of view of fourth-stage female students, to identifyOn the difficulties and obstacles to achieving quality performance through field application from the students’ point of view for the topic (school administrative procedures, learners, cognitive achievement, school tools).The researchers used the descriptive approach in the research procedures as it is an appropriate approach to achieve the research objectives.,The following questions were asked:There are obstacles and difficulties faced by female students during the process of choosing schools, dealing with school administrations, and the difficulties fa

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Publication Date
Tue Sep 14 2021
Journal Name
International Journal Of Advanced Biological And Biomedical Research
Candida Berkh. (1923) Species and Their Important Secreted Aspartyl Proteinases (SAP) Genes Isolated from Diabetic Patients
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Candida Berkh. (1923) occurs naturally in the body. But it becomes opportunistic fungi, meaning that it infects humans when there is any weakening of the immune system, such as exposure to chemotherapy, diabetes, or organ transplantation. Most species of Candida grow at a temperature between 20-40 °C and have a pH of 3-8. Human pathogens of Candida species include C. albicans, C. glabrata, C. lusitaniae, C. parapsilosis, C. tropicalis and C. utili. C. albicans has many virulence factors that facilitate injury process. Virulence factors are considered as a measure of pathogenicity, and it is in the form of fungal toxins, enzymes, or cell structures that facilitate infection, as well as pathogen resistance in different conditions. This study

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