Want Your Doctor to Write Back?

Corresponding with your doctor through an online portal like MyChart can be incredibly convenient. But apparently, how you write your message may influence whether your doctor responds.

One of my patients was prescribed medication for stomach pain. Unfortunately, the pain didn't improve — it got worse. She messaged her specialist doctor through the clinic's online portal but received no response. When I eventually raised my concerns with the specialist, my patient received a one-sentence reply telling her to schedule an appointment.

Later that week, another patient mentioned that same doctor. Her experience couldn't have been more different. She praised the doctor for responding promptly and providing helpful advice through the portal.

Why the difference? I can't be sure. But a recent study in JAMA Network Open provides a possible clue.

My first patient is about 50 and graduated from high school. The second is about the same age but has a master's degree.

Researchers examined more than 3.6 million messages sent by adults to primary-care practices. They found that messages from Black and Hispanic patients, people with only a high school education, and Medicaid recipients were less likely to receive a response. For example, Black patients were about 12 percent less likely than White patients to receive a response from the clinician they had messaged.

I would have guessed the explanation was what patients were asking about. It wasn't. Message content explained relatively little of the difference.

Instead, writing style accounted for roughly 60 percent of the gap in clinician response rates between patients with a high school education and those with a college education.

Even a simple greeting was associated with a striking difference. Messages with no greeting received a response from the intended clinician about 26 percent of the time. Messages beginning with the clinician's last name—such as “Dear Dr. Smith”—received a response about 39 percent of the time. Clearer messages, especially those containing a clear question, were also more likely to receive responses.

The study doesn't prove that writing style caused doctors to respond differently, but that's not particularly reassuring. Online messages have become an important gateway to medical care, and your message may not go directly to your doctor. A nurse or medical assistant may first scan dozens of messages, deciding which need an immediate response and which should be forwarded to the doctor. In that environment, writing style may unintentionally signal which messages deserve attention.

So what’s the answer for a patient? Do they need to just ask AI to rewrite the message for us?

Well, I think we've got that backward.

AI may actually help — but the burden shouldn't be on patients to write like someone with a master's degree. Health systems could use AI to identify the medical problem behind a message, regardless of whether it begins “Dear Dr. Smith,” contains perfect grammar, or is elegantly written.

I don't know why my two patients received such different responses.

But getting your doctor's attention shouldn't depend on how well you write.

– Dr. Michael Wilkes with a Second Opinion

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