Researchers at Columbia University’s Mailman School of Public Health have released a study that sheds light on how the way patients write messages in online portals can affect whether doctors respond promptly. Analyzing more than 3 million message threads from the Mass General Brigham health system, the team examined a sample of one million messages to identify patterns that influence clinician reply rates.
Writing style accounts for much of the response gap
The study found that differences in writing style—such as beginning a note with a greeting, using expressive punctuation, and providing more detail—explain roughly half of the response disparities observed among historically marginalized patients, including non‑White individuals, those without a college degree and Medicaid recipients.
Messages that opened with a formal greeting like “Dear Dr. Liu” were significantly more likely to be answered by the intended physician. Including the clinician’s first name boosted the odds even further, nearly doubling the likelihood of a direct response compared with messages that lacked any greeting.
Expressive punctuation also mattered. Messages that contained multiple question marks or exclamation points received higher response rates than those with a single mark, and those with no punctuation at all lagged behind.
Length and tone influence triage decisions
Contrary to the common advice for brief, concise notes, the analysis showed that longer messages were more often escalated through the portal’s triage system and ultimately reached the target doctor. Researchers suggest that length may signal complexity or specificity, prompting staff to forward the note rather than handling it with a quick template response.
Positive sentiment—such as noting improvement in a condition—correlated with higher response rates, while expressions of frustration or sadness slightly reduced the chance of a direct reply.
Implications for patients and providers
Dr. Mitchell Tang, the study’s lead author, cautioned against blaming patients for the gaps. “The best way of dealing with this is actually to try to improve the system working on the back end,” he said, emphasizing the need for clinician‑side education and system‑level adjustments.
He also raised the possibility of using artificial‑intelligence tools to help patients draft clearer, more effective messages, potentially leveling the playing field for those who lack formal writing training.
Patients should remember that portal messages are not intended for urgent matters. The study notes that many health systems triage incoming notes through nurses or medical assistants before they reach a physician, and response times can extend to two business days. For urgent concerns, a phone call or scheduled appointment remains the recommended course.
Broader context
Use of patient portal messaging has surged since 2020, while traditional phone calls have declined. The volume increase raises concerns about physician workload and burnout, prompting some providers to suggest that more complex questions be addressed through scheduled visits rather than multiple back‑and‑forth messages.
While the findings are based on a single health system and only English‑language messages, they highlight actionable steps for both patients and providers to improve communication and reduce inequities in access to timely medical advice.
Original reporting: El Paso News (HLL/CB) — read the source article.
