You’ve probably stared at a patient-portal message box wondering how much information your doctor actually needs. Should you write three sentences or three paragraphs, start with “Dear Dr. Smith,” explain every symptom you’ve had for two weeks, or simply type, “Can someone call me?” New research suggests that the way we write patient portal messages may be associated with whether the intended clinician responds, even after researchers account for what the message is actually about. A JAMA Network Open study published August 24 analyzed more than 3.6 million message threads from over 511,000 adult patients and found associations between writing characteristics and care-team responses. The findings don’t guarantee that changing your writing will get your doctor to answer, but they offer some useful clues about making a portal message easier to understand and act on.
Don’t Make the Message Too Short
“Need refill” may seem efficient, but extremely short messages weren’t associated with the strongest response rates in the study. Among the researchers’ random sample of nearly 1 million English-language threads used to analyze writing characteristics, only 69% of messages containing 4 to 25 words received any care-team response, compared with 80.9% of messages containing 51 to 100 words. Messages between 101 and 200 words had an 81.7% care-team response rate, while messages longer than 200 words dropped slightly to 76.8%. Those raw numbers don’t prove that simply adding words causes a better response, because the researchers also found that the type of request itself influenced responses. Still, when writing patient portal messages, giving enough context for the care team to understand what happened and what you need may be more useful than sending a cryptic one-liner.
Put Your Actual Question in the Message
Here’s one of the most interesting findings: question marks were associated with higher response rates. In the study’s descriptive data, messages containing no question mark received a care-team response 72.8% of the time, compared with 82.9% for messages with one question mark and 86.1% for those containing multiple question marks. The researchers’ adjusted analysis also found question marks were associated with a higher likelihood of receiving a response from the intended clinician after accounting for factors including message content and patient characteristics. That doesn’t mean adding “???” randomly will magically move your message to the front of the line. Instead, make the request unmistakable: “Should I continue taking this medication?” or “Do I need an appointment for this symptom?” gives the recipient something specific to answer.
Addressing the Clinician by Name May Help Clarify Your Message
How patients opened patient portal messages was another characteristic associated with response patterns. Messages beginning with the clinician’s first name had a 44.8% target-clinician response rate in the descriptive data, compared with 38.7% when the last name was used, 26.9% for a greeting without a name, and 25.7% for no greeting at all. Importantly, those raw percentages shouldn’t be interpreted as proof that typing someone’s first name causes the doctor to answer, because different patients and clinical circumstances can produce different messaging patterns. The researchers’ adjusted analysis nevertheless found that openings using the target clinician’s name were positively associated with a response from that clinician. A natural opening such as “Hi Dr. Patel,” followed immediately by your reason for writing can make it obvious whom you’re trying to reach without turning the message into a formal letter.
Give the Details That Change the Medical Question
Length matters less than whether the information you’re providing helps the care team understand what’s going on. If you’re messaging about dizziness, for example, “I’ve been dizzy lately, what should I do?” gives far less context than explaining when it started, how frequently it occurs, whether anything triggers it, and whether you’ve recently changed medications. The study classified messages into 20 topics and found that message content itself was significantly associated with how care teams responded. Response patterns varied considerably across requests involving refills, test results, blood pressure, referrals, respiratory symptoms, pain, mental health, and other topics. When writing patient portal messages, focus on the handful of facts that could change the answer instead of either withholding important context or providing a complete autobiography.
Make the Next Step You’re Requesting Obvious
Imagine receiving 50 messages saying variations of “My knee still hurts” without explaining what the sender wants you to do. One patient may need medication advice, another may want a referral, another may be reporting a worsening symptom, and someone else may simply be providing the update requested during a previous visit. A more actionable message might end with, “The pain hasn’t improved after two weeks of the exercises you recommended. Should I schedule another appointment or continue them another week?” The JAMA study found substantial differences in response patterns depending on message topic, reinforcing that not every portal request is handled the same way. A clear requested next step can make patient portal messages easier to triage even though the research doesn’t establish that any particular phrasing guarantees a response.
Don’t Assume “Please” Is the Secret Ingredient
One finding may surprise anyone who was taught that extra politeness always produces better service. In the descriptive data, messages containing the word “please” actually had a lower overall care-team response rate. In fact, there was a 73.6% response rate compared with 79.1% among messages that didn’t contain it. That absolutely does not mean being polite makes doctors ignore you, because “please” could appear more frequently in certain kinds of requests or circumstances, and observational associations don’t establish cause and effect. Messages containing “thanks,” meanwhile, had a slightly higher descriptive response rate than those without it, 78.4% versus 76.4%. The useful lesson isn’t to remove courtesy from patient portal messages, but to prioritize clarity over trying to find a magic word that supposedly unlocks a response.
Remember That the Study Found Something Bigger Than Writing Tips
The research wasn’t originally designed simply to teach patients how to write better messages. Investigators were studying disparities in portal responses and found that Black and Hispanic patients, people with only a high-school education, and Medicaid beneficiaries received lower levels of care-team response than comparison groups. For example, Black patients had a target-clinician response rate 3.7 percentage points lower than White patients after adjustment for several patient and operational factors, which researchers described as an 11.6% relative reduction. Message content didn’t explain those disparities, while writing style accounted for 48% of the difference for Black patients, 34.9% for Hispanic patients, 60.5% for patients with only a high-school education versus a college degree, and 42.8% for Medicaid patients versus commercially insured patients. The authors concluded that writing style could represent a source of bias in message triage, meaning health systems (not merely individual patients) have reason to think about how messages are evaluated.
Know When a Portal Message Isn’t the Right Tool
No writing technique turns a patient portal into an emergency department. The study examined medical-advice messages sent through one large academic health system, and its findings shouldn’t be interpreted as instructions to use messaging for symptoms requiring immediate evaluation. If you’re experiencing potentially life-threatening symptoms, follow your health system’s emergency guidance rather than waiting for someone to open a perfectly worded message. For ordinary nonemergency questions, however, a useful formula is straightforward: identify the issue, give the relevant timeline and details, explain what’s changed, and finish with the specific question you need answered. That’s a better goal for patient portal messages than trying to reverse-engineer punctuation or wording purely to increase the odds of a reply.
Clear Beats Clever When You’re Asking for Medical Help
The new research doesn’t provide a guaranteed script that forces your physician to respond, and its observational design means the associations shouldn’t be mistaken for cause and effect. What it does show is that patient portal messages aren’t being processed in a vacuum: their topic, length, opening, punctuation, complexity, and other writing characteristics were associated with how care teams responded. For patients, the practical takeaway is to provide enough useful context, clearly identify the question, and make the requested next step easy to understand. For healthcare systems, the findings raise a bigger concern about whether differences in communication style can inadvertently contribute to unequal treatment during message triage.
When you message your doctor through a patient portal, do you usually write a detailed explanation or keep it as short as possible? Share your approach in the comments.
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