How to Get a Doctor to Reply to Your Patient Portal Message

The Triage Mechanics Behind Patient Portal Messages

Portal messaging has become a routine way for patients to communicate with their health care team. Yet investigators pointed out that a physician’s assistant or nurse practitioner often replies to these communications instead of the actual doctor.

Lead researcher Mitchell Tang, an assistant professor of health policy and management at the Columbia University Mailman School of Public Health in New York City, explained that patients are frequently unaware these inquiries bypass their personal physician’s direct inbox. Rather than going straight through, investigators noted that inquiries undergo an initial screening where fellow medical staff members evaluate them, assess how complex and urgent they are, and determine if forwarding them to the attending physician is warranted.

Tang observed that nurses and medical assistants tasked with message sorting must rapidly evaluate these submissions and make critical determinations regarding their escalation needs, urgency, and complexity. Given those constraints, writing style may understandably influence how messages are perceived and prioritized.

Four Writing Style Factors That Influence Physician Response Rates

The study analyzed millions of patient portal messages, examining features like length, formality, sentiment, and greeting style. Results showed that certain specific factors made it more likely a doctor would personally respond:

• Proper Salutations: A greeting that included either a physician’s last name or both their first and last name. Simply beginning a message with “Dear Dr. Tang” seemed to make it much more likely that Dr. Tang would end up responding, Tang noted.
• Positive Sentiment: A positive sentiment, as opposed to a neutral or negative tone, increased the likelihood of a direct physician reply.
• Message Length: More lengthy messages, with those of 100 words or more, received greater attention from doctors.

Conversely, the data revealed that certain stylistic variations had a surprisingly minimal effect on whether physicians replied. For example, the number of exclamation marks or question marks in the message did not seem to deter doctors, the study found. Physicians replied just as frequently to unpolished submissions lacking “thanks” or “please” as they did to exceptionally courteous notes. Additionally, literacy levels proved inconsequential, as communications drafted at a third- to sixth-grade reading level achieved the same reply rates from doctors as those written at a collegiate standard.

Addressing Disparities in Digital Health Communication

Results showed that historically marginalized groups tended to have lower response rates from doctors. For example, Black patients had a response rate nearly 4 percentage points lower than white patients. Data indicated that direct physician replies were also less common among individuals with lower educational attainment, those whose primary language was not English, and beneficiaries of Medicaid or Medicare/Medicaid.

However, analysis revealed that writing style accounted for some of this gap in response rates. Style factors accounted for 48 percent of the difference between Black and white patients, 35 percent of the difference between Hispanic and white patients, nearly 61 percent of the difference between those with a high school diploma versus a college degree, and 43 percent of the difference between Medicaid patients and those with private insurance.

Tang pointed out that these insights could assist healthcare organizations in pinpointing potential biases within portal message screening procedures and in fostering fairer methods for online correspondence. But they are also a reminder to think about how communication style can influence the way people perceive and respond to people, not only in health care, but in everyday life.