How Messaging in Patient Portals Impacts Care
/By Crystal Lindell
What you write in texts and messages to your doctor can impact the quality of care that you receive, according to a new study published in JAMA.
Researchers at Harvard and Columbia University analyzed over 3.5 million patient messages sent by over half a million patients through patient portals like MyChart. They wanted to see how a patient’s race, education and other demographics might influence how doctors respond to their messages.
Researchers found “substantial differences” in how providers responded to historically marginalized groups, such as Blacks and Hispanics, but found that a patient’s writing style had more impact on how care teams responded. If they were polite and positive, a patient was more likely to get a response.
“Writing style was a more important factor. Seemingly minor differences among messages, such as whether the opening included the target clinician’s name, were associated with significantly different response rates,” researchers reported.
For example, when patient messages included a clinician’s last name in the opening line, such as “Dear Dr. Smith,” those messages had a 38.7% response rate.
But when a message had no greeting at all -- no salutation or even a simple “hello” – those messages had just a 25.7% response rate.
Providers were also more likely to respond to messages that had a positive sentiment; used expressive punctuation such as question and exclamation marks; and higher word counts.
To illustrate what they found, researchers asked ChatpGPT to write two messages from the perspective of a patient with respiratory symptoms.
One message was polite and positive – written in a way to get a high response rate:
"Dear Dr. Liu,
I hope you're doing well! I wanted to reach out because I've been experiencing some new respiratory symptoms that I'm a little concerned about and would really appreciate your perspective. Over the past two days, I've developed a dry, persistent cough along with some chest tightness and mild shortness of breath -- especially when walking or going up stairs.
I haven't had a fever, but the symptoms are definitely noticeable and seem to be getting a bit worse, which is making me wonder if there could be something more going on? I know you've helped me manage my asthma in the past, could this be a flare-up or something else entirely??
Thanks so much again for all you do! I really appreciate your time and guidance.
Warmly,
Peter Parker
The other patient message was short and blunt – written in a way that researchers thought would get a poor response rate:
"I've had a cough and congestion for a few days now, and it's been pretty uncomfortable. Still no fever, but it's been dragging on and making it harder to get through the day."
See the difference? The more polite and positive message, though much longer, is more likely to get a response. Writing style was a possible explanation for about half of the disparities that researchers found in response rates.
“In many message triage systems, nurses and medical assistants must quickly assess messages — often with little context — and make snap judgments on their urgency, complexity, and need for escalation. Given these constraints, it is not surprising that writing style factors might influence the triage process,” researchers said.
Patient portals provide an easy and convenient way for patients to send messages to their physicians, but put an extra burden on doctors to respond. Some do and some don’t – depending on the patient.
So the next time you write a text or message to your doctor, make an effort to be polite and positive. Use words like “please” and “thanks.” Simply being polite can have some surprisingly positive outcomes.
