Getting a doctor to respond through a health portal requires more than just clear symptoms; the way a message is written determines if a nurse passes it along, according to new research from Columbia University.
Most patients assume their message goes straight to the doctor’s inbox, but the system works differently. A care team member reviews every incoming request and decides which ones merit the doctor’s attention based on urgency.
Researchers at Columbia University’s Mailman School of Public Health analyzed over 3.6 million messages sent by more than 510,000 patients during a two-year period. They found that writing style often determines how a message is prioritized rather than the content itself.
Mitchell Tang, an assistant professor at the school and first author of the study, noted that the team was surprised by the results. “We thought it would be partly message content and partly writing style,” Tang told TheDoctor.
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Writing style plays a key role because care team members must make rapid decisions about which messages require immediate action. The findings could help health systems identify potential sources of bias in portal messaging.
The numbers behind the bias
Patients from marginalized groups—such as people of color, those who preferred a foreign language, and those with less education—were less likely to receive a response from their care team or provider. The researchers used natural language processing to analyze the messages’ content and writing style.
Writing style accounted for a significant portion of the disparity in response rates. It explained 48 percent of the difference in response rate between Black patients and white patients and 35 percent of the difference between Hispanic and white patients.
The gap was even wider when looking at education levels. Writing style accounted for 60.5 percent of the difference between patients with a high school diploma and those with a college degree. For patients on Medicaid versus those with commercial insurance, the difference was 43 percent.
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Patients from these groups can write messages quite differently, Tang explained. Those differences can make it less likely that a doctor will respond.
Tang suggested that the writing style disparity may stem from socioeconomic factors rather than a lack of medical knowledge. The ability to use expressive punctuation or a formal salutation may correlate with higher education or familiarity with digital communication tools.
How to get a reply
Getting the most out of a telehealth appointment starts before the video call begins. Tang offered several tips for patients hoping to secure a response from their physician:
- Use the doctor’s name in the opening of the message.
- Use expressive punctuation, such as exclamation points and question marks.
- Keep your tone friendly and positive.
- Make your questions as specific as possible.
- Include a higher word count to make the message appear more meaningful.
- Be clear about symptoms—when they occur, how often they happen, and how intense they feel.
- Check spelling and re-read the message before sending.
