How You Write a Message to Your Doctor Could Affect Who Responds

The way patients write messages to their doctors could influence whether they receive a response from the intended physician, according to a new study published in JAMA Network Open.

Researchers analyzed more than 3 million patient message threads from the Mass General Brigham electronic health record system. In a sample of 1 million messages, researchers found that differences in writing style accounted for about half of the disparities in response rates among historically marginalized groups.

Those disparities have previously been documented among non-White patients, people without a college education and patients using Medicaid rather than commercial insurance.

Dr. Mitchell Tang, an assistant professor of health policy and management at Columbia University's Mailman School of Public Health, led the study. He said the findings should not place responsibility on patients to change how they communicate.

"I want to be cautious not to victim-blame here," Tang said. "The best way of dealing with this is actually to try to improve the system working on the back end."

The greeting may matter

The study found that messages beginning with a greeting such as "Dear Dr. " were more likely to receive a response from the intended clinician.

Messages using the doctor's first name had even higher response rates, with researchers finding they were nearly twice as likely to receive a response from the target clinician compared with messages that included no greeting.

Punctuation and tone

Expressive punctuation was also associated with higher response rates. Messages containing multiple question marks or exclamation points were more likely to receive a response than messages using single marks or none.

Positive language also appeared to make a difference. Messages containing positive sentiment were associated with somewhat higher response rates, while messages expressing frustration or sadness were associated with slightly lower rates.

Longer messages may get more attention

Although patients are often encouraged to keep portal messages brief and focused, the study found that longer messages were more likely to reach the clinician they were intended for.

Tang said message length may serve as an indicator that a patient's issue is more complicated or specific and therefore more likely to be escalated by the portal's triage system.

Patient portal messages do not always go directly to a doctor. They may first be reviewed by a medical assistant or nurse before being answered or forwarded to the intended clinician.

The study examined only one health system and messages written in English, so the findings may not apply to every medical practice.

When to message your doctor

Patient portal use has increased substantially since 2020, while traditional phone calls to medical offices have declined. The increase has also contributed to concerns about physician workload.

Researchers say portal messaging is generally better suited for non-urgent questions. Tang told CNN that patients should be comfortable waiting up to two business days for a response. If an issue is more urgent, patients should call their doctor's office instead.

For more complicated concerns, the American Medical Association has also advised patients to consider scheduling an appointment rather than trying to resolve the issue through a series of portal messages.

Tang said the findings could eventually lead to tools that help patients communicate more effectively, including artificial intelligence systems that assist with drafting portal messages.