Telehealth has taken off. For certain kinds of consultations, an online appointment saves both patients and providers time and trouble. The number of messages patients sent to their providers via online portals spiked during the COVID-19 pandemic.

Patient portals remain a good way for people to seek medical advice, but how you reach out to your provider matters — especially if you hope to get an answer from your physician.

The content of the message was not associated with response rates, instead, writing style often determined how a patient's message was prioritized by staff members.

Many people don't realize that their message may not go directly to the doctor's inbox. Instead, a care team member such as a nurse reviews these messages and decides which ones will be forwarded to the doctor based on their level of urgency.

How these messages to providers are written, as much as what they say, plays a key role in whether they get a response and by whom, researchers at Columbia University's Mailman School of Public Health found.

The researchers were surprised that the content of the message was not associated with response rates, Mitchell Tang, first author on the study, told TheDoctor. “We thought it would be partly message content and partly writing style.”

Writing style can determine how a patient's message is prioritized because care team members must quickly decide how urgent a message is.

The findings could help health systems identify potential sources of bias in portal messaging.

The researchers analyzed over 3.6 million messages sent by more than 510,000 patients during a two-year period. Patients from marginalized groups, such as people of color, those who preferred a foreign language, those with less education and those who were eligible for Medicaid or eligible for both Medicaid and Medicare, were less likely to receive a response from their care team or their provider.

Patients from each of these groups can write messages quite differently, Tang said. Those differences can make it is less likely that a doctor will respond.

The findings could help health systems identify potential sources of bias in portal messaging. “They are also a reminder about how communication style can influence how we perceive and respond to people, not only in healthcare, but in everyday life,” said Tang.

The researchers used natural language processing to analyze the messages' content and writing style. Writing style accounted for 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; 60.5 percent of the difference between patients with a high school diploma and those with a college degree; and 43 percent of the difference between patients on Medicaid and those with commercial insurance.

Tang, an assistant professor of health policy and management at the Columbia University Mailman School of Public Health, had a few tips for getting a response from the doctor:

  • Use the doctor's name in the opening of the message. Starting the message with "Dear Dr. Jones" rather than jumping into the details of your message makes it more likely that Dr. Jones is the one who will end up responding.

  • Use expressive punctuation, such as exclamation points and question marks.

  • Keep your tone friendly and positive.

  • Make your questions as specific as you can so they can be answered.

  • Messages with a higher word count tend to be more meaningful and are more likely to be perceived as important and passed along to the doctor.

  • Be as clear as you can about your symptoms — when they occur, how often, what they feel like and how intense they are.

  • Re-read your message and check your spelling before sending. Use your computer's software if necessary.

For patients, the idea is to clearly convey your symptoms and their impact and give your doctor the information he or she needs. This will make it more likely they will be able to offer help that is useful. An in-person visit may still be necessary, but at least you will have gotten the most out of your telehealth appointment.

The study is published in JAMA Network Open.