https://in.bgu.ac.il/en/fohs/communityhealth/Family/Documents/DOCTOR-PATIENT%20COMMUNICATION%20A%20REVIEW%20OF.pdf

Doctor-patient communication: a review of the literature.

Objective. —To identify specific communication behaviors associated with malpractice history in primary care physicians and surgeons. Design. —Comparison of communication behaviors of "claims" vs "no-claims" physicians using audiotapes of 10 routine office visits per physician. Settings. —One hundred twenty-four physician offices in Oregon and Colorado. Participants. —Fifty-nine primary care physicians (general internists and family practitioners) and 65 general and orthopedic surgeons and their patients. Physicians were classified into no-claims or claims (≥2 lifetime claims) groups based on insurance company records and were stratified by years in practice and specialty. Main Outcome Measures. —Audiotape analysis using the Roter Interaction Analysis System. Results. —Significant differences in communication behaviors of no-claims and claims physicians were identified in primary care physicians but not in surgeons. Compared with claims primary care physicians, no-claims primary care physicians used more statements of orientation (educating patients about what to expect and the flow of a visit), laughed and used humor more, and tended to use more facilitation (soliciting patients' opinions, checking understanding, and encouraging patients to talk). No-claims primary care physicians spent longer in routine visits than claims primary care physicians (mean, 18.3 vs 15.0 minutes), and the length of the visit had an independent effect in predicting claims status. The multivariable model for primary care improved the prediction of claims status by 57% above chance (90% confidence interval, 33%-73%). Multivariable models did not significantly improve prediction of claims status for surgeons. Conclusions. —Routine physician-patient communication differs in primary care physicians with vs without prior malpractice claims. In contrast, the study did not find communication behaviors to distinguish between claims vs no-claims surgeons. The study identifies specific and teachable communication behaviors associated with fewer malpractice claims for primary care physicians. Physicians can use these findings as they seek to improve communication and decrease malpractice risk. Malpractice insurers can use this information to guide malpractice risk prevention and education for primary care physicians but should not assume that it is appropriate to teach similar behaviors to other specialty groups.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=414233&pdfFileName=jama_277_7_034.pdf

Physician-Patient Communication: The Relationship With Malpractice Claims Among Primary Care Physicians and Surgeons

WHO Regional Office for Europe.

https://www.cell.com/cell/pdf/0092-8674(90)90690-G.pdf

An internal deletion within an 11p13 zinc finger gene contributes to the development of Wilms' tumor.

The Wilms tumor suppressor gene wt1 encodes a zinc finger DNA binding protein, WT1, that functions as a transcriptional repressor. The fetal mitogen insulin-like growth factor II (IGF-II) is overexpressed in Wilms tumors and may have autocrine effects in tumor progression. The major fetal IGF-II promoter was defined in transient transfection assays as a region spanning from nucleotides -295 to +135, relative to the transcription start site. WT1 bound to multiple sites in this region and functioned as a potent repressor of IGF-II transcription in vivo. Maximal repression was dependent on the presence of WT1 binding sites on each side of the transcriptional initiation site. These findings provide a molecular basis for overexpression of IGF-II in Wilms tumors and suggest that WT1 negatively regulates blastemal cell proliferation by limiting the production of a fetal growth factor in the developing vertebrate kidney.

http://science.sciencemag.org/content/sci/257/5070/674.full.pdf

Repression of the insulin-like growth factor II gene by the Wilms tumor suppressor WT1.

Abnormality of chromosome 11 in patients withfeatures of Beckwith-Wiedemann syndrome

We report the clinical and chromosomal findings in 8 patients with deletions of the long arm of chromosome 4. Four of these patients appear to have terminal deletions beginning in band 4q31, and therefore, lack the digital 1/3 of the long arm of chromosome 4. We confirm that deletion of 4q31 leads to qter causes a recognizable syndrome, and we further define the phenotype of that syndrome. A 5th patient has a horter terminal deletion, ie, 4q33 leads to qter. This deletion causes a milder phenotypic expression than that seen in the severe 4q terminal-deletion syndrome. The remaining 3 patients have interstitial deletions of the long arm of the 4th chromosome, including segments 4q21.1 leads to q25, 4q21.3 leads to q26, and 4q27 leads to q31.3. The phenotypic expression noted in these patients is variable in differs from the 4q terminal-deletion syndrome.

Deletions of different segments of the long arm of chromosome 4.

Maternal hyperphenylalaninemia fetal effects

The study assessed the psychometric properties of the Medical Communication Behavior System. This observation system records time spent by the physicians and patients on specific behaviors in the categories of informational, relational, and negative situation behaviors by using hand-held electronic devices. The study included observations of 101 genetic counseling sessions and also assessed the outcome measures of patient knowledge and satisfaction. In addition, 41 of the sessions were rated using the Roter Interactional Analysis System, and 20 additional control subjects completed the post-counseling information without being observed to examine the effects of recording the session. Results showed good interobserver reliability, and evidence of concurrent, construct, and predictive validity. No differences were found between the observed and unobserved groups of any of the outcome measures.

https://www.jstor.org/stable/pdfplus/3765069.pdf

James A. Bartley

Papers

Abnormality of chromosome 11 in patients withfeatures of Beckwith-Wiedemann syndrome

Deletions of different segments of the long arm of chromosome 4.

Maternal hyperphenylalaninemia fetal effects

Medical Communication Behavior System. An interactional analysis system for medical interactions.

X -linked Progressive Cone Dystrophy: Clinical Characteristics of Affected Males and Female Carriers