The Portal Message Gender Gap
Women, whether as patients or doctors, frequently use the patient portal; however, this workaround might increase frustration for both groups.
TL;DR: The apparent convenience of portal messages in healthcare may be overshadowed by their lack of depth in patient-doctor relationships and potential costs; women are facing the brunt of this terrible communication. Women-focused direct care models may offer a promising alternative for more personalized healthcare investment.
As I daydream about redefining women’s digestive and rectal care, my thoughts often converge on the concept of ‘ease of communication’ with healthcare providers. This re-imagination is primarily about transforming the reliance on portal messages, which, while useful for scheduling appointments or refilling prescriptions, fall short in nurturing substantial doctor-patient interactions. I don’t feel seen when writing or receiving a portal message—do you?
Portal messages might be convenient, but the critical question remains:
Are they effective for meaningful communication? Do I feel taken care of?
At the end of the day both female patients and doctors are highly utilizing this method of communication. Female patients are more likely to use portal messaging, choose a female doctor to answer their questions and alas, female doctors receive more messages than their male doctor colleagues.1-3
The Problem with the Portal
Reflecting on my pivot from conventional private practice, I recall the frustration with the detached and delayed communication via portal messages that I, regrettably, had to use due to the corporatization of medicine. Previously, my patients had direct access to my nursing team and, thereby, to me, ensuring a personalized and efficient communication channel. However, unexpected administrative changes led to an impersonal triage system, phone calls went to a pool of nurses and portal messages went to a triage nurses inbox. In one instance, this delay resulted in a patient firing me after I did not get back to them within 4 days while I was on hospital call over the Thanksgiving holiday. This incident not only troubled me deeply but also highlighted the inadequacies of our medical systems and technology in maintaining the integrity of patient care.
The truth is, while portal messages may contribute to physician burnout (including my burnout!), they often fall short as a communication method. Despite the constraints—like a nursing shortage and high patient turnover rates—digital communication has become a necessity. Research reveals that female physicians are more engaged with the electronic health record (EHR), documenting thoroughly and receiving a higher volume of patient messages compared to their male counterparts, a disparity that may reflect the meticulous care women doctors provide.4 One study found that female PCPs receive 26% more patient messages monthly than male PCPs.5 This portal message gender gap is likely even wider now as a 2023 report by the Journal of the American Medical Informatics Association (JAMIA) reported that patient portal messaging has surged by 157% since pre-pandemic times.6
Getting to the Root of the Problem to Build a Solid Patient-Doctor Foundation
However, the time spent reviewing portal messages can detract from productivity and patient care, leading to burnout and delays in treatment. Not to mention, the foundation of a strong doctor-patient relationship is not built on portal messages. Now, with healthcare institutions starting to charge for this communication—sometimes as much as $50 per message—patients and doctors alike are forced to reconsider the value of the current healthcare model. A UCSF Health study from January found that implementing and informing patients of potential charges (depending on the complexity of their message request) cut down the average weekly number of messages from 59,648 to 57,925 and average weekly message threads from 19,739 to 16,838. Once again, we apply a band-aid to a broken system rather than address the core issue: patients and doctors need more time together to improve health outcomes.
AI Might Not Be the Solution We Crave
A recent study discovered that while AI-generated draft replies to patient messages did not reduce the time doctors spent managing their inboxes, they did help lower feelings of burnout. While these AI-assisted responses may alleviate some of the exhaustion female doctors experience with inbox management, questions about their overall effectiveness remain. Can these AI drafts truly free up more time for face-to-face patient consultations, extend the length and quality of those interactions, or enable more telephone calls within the workday? I am skeptical that using AI this way will improve doctor-patient interactions or lives for women in general.
As a lady patient, I don’t want to have an AI-generated message sent to me if I messaged the doctor with a concern.
Against this backdrop, an alternative emerges: women-centric direct care practices, where a retainer model affords patients more attentive and personalized care. Here, you could benefit from direct calls or secure texting with doctors who truly know you—doctors with fewer patients and can afford to invest more in your women’s health. Pioneers like Dr. Knope, an advocate for direct care medicine, argue that the most significant investment is in your health.
Loved this article →Jane (or Dr Doe?) Will Reply to Your Patient Portal Message Now 4
With a higher volume of electronic messages to manage, female physicians are also expected to conform to gendered expectations of physician communication style (eg, longer visit, giving more positive verbal and nonverbal cues such as smiling), while simultaneously receiving messages addressed informally to their first name instead of professional title.4,7
As healthcare evolves, it's crucial to consider options like Ms. Medicine clinics, where the emphasis is on listening to female patients and addressing their our concerns directly.
This push for systemic change in healthcare communication aims to prioritize direct, meaningful patient-doctor interactions that elevate the quality of care.
The conversation about healthcare communication is more than just portal messages—it's about the value of human connection in medicine. It's time to reassess and reallocate our healthcare dollars towards a progressive model that not only listens but also truly hears.
End Dictation.
Your Lady MD,
Emily