Patient-friendly offices may lower liability risks. (Follow-Up for at-Risk Patients in Crucial).

KAUAI, HAWAII -- When jurors in some medical malpractice cases "send a message" with a judgment of $10 million or more, on the surface they're judging the physician or the practice on trial.

But they also may be sending a message about their own physicians who don't return phone calls or give them an option to speak to a live person when they call the office or who keep them waiting for at least an hour, Maureen C. Mondor said at a conference on obstetrics, gynecology, perinatal medicine, neonatology, and the law.

To help physicians build a patient-friendly practice and send patients a positive message, institute the following measures, said Ms. Mondor, who is vice president of clinical risk management services for ProMutual Group, Boston:

* Policies and procedures. These need to be practical. Start with a philosophy about your practice for patients to read. For example, "Do you believe in VBAC [vaginal birth after cesarean section]? Will you do them? Deal with this up front," she said.

If a patient comes in with a list of questions, your standard procedure should be to put it in the patient's record and document that you discussed the list with her.

Gudielines for prenatal care should include when and how often to do risk assessments, who should be tested, and other issues surrounding tests such as amniocentesis or other genetic screening, group B streptococcus, or alpha-fetoprotein. Specify how results should be communicated to the patient; never leave them in a message on a telephone answering machine.

Develop protocols and have everyone in your practice follow them. "Often in group practices, 10 physicians are like 10 different practices. You need some standardization," Ms. Mondor said at the conference sponsored by Boston University.