By Jason Bae

A news headline reads: “Popular heartburn medicine increases dementia risk by 33%.” Your heart sinks. Should you message your doctor and ask whether you should stop your heartburn medication?

The answer may seem like an obvious yes. But what if I told you that, patient messages are a leading driver of doctor burnout?

Since the COVID-19 pandemic, more people have turned to patient portals — a secure online health platform — to communicate with their doctors via online messaging.

Patient portals are an indispensable tool for patient care. In my urgent care practice in Palo Alto, patients send me messages requesting medication refills, asking clarifying questions about a recent visit or to give an update on their symptoms, including an occasional “I am all better, thank you doc.” Most messages take little time to address or can be handled by other staff.

Yet, for many doctors, especially primary care doctors who often care for more than 2,000 patients at a time, patient messages can get overwhelming fast.

Patients ask their doctor to comment on a new therapy after seeing an ad online, adjust their medications or opine on studies ordered by other doctors. Patients frequently message about a new symptom — or a myriad of symptoms. One message may simply read: “I have been fatigued and not sleeping well for the last week. What do you think is going on?” Another may be a multipage account of symptoms that would end with “Can you please get back to me today?”

However, text messaging is simply not an appropriate communication medium for diagnosing and treating many symptoms. For example, fatigue is most often from benign — and unknowable — causes but can also be the result of anemia, hypothyroidism, depression or infection, all of which require more detailed history and examination if not laboratory or imaging tests to diagnose.

Moreover, these messages often feel transactional and clerical and are among the least satisfying doctor-patient interactions. Doctors rarely get compensated for the multiple hours a week on average they spend responding to patients online, which often happens in pajamas at night.

Yet, it would be wholly irresponsible to blame patients for physician burnout or messaging their doctors.

For one, it’s not just patient messages that fill up a doctor’s inbox, but also lab results, requests from pharmacies and notes or messages from other providers.

Many patients feel compelled to reach out to their doctors when news and social media sites feed them with attention-grabbing and anxiety-provoking health information for more pageviews and profit (by the way, there is no good reason to believe heartburn medications cause dementia despite the misleading headline). The disclaimers always say, “You should talk to your doctor.”

However, many find it impossible to get a hold of their doctor — except via patient portals. The next available in-person appointments are often in weeks, if not months. Many older or socioeconomically disadvantaged patients lack the technical capabilities to access virtual visits that may have sooner availability. Wait times at an urgent care clinic and emergency rooms are often a few hours or more.

For most people, messaging their doctor is the only viable choice when they have a new health concern.

Yet, we must address the patient message issue along with other trends in medicine — such as increasing administrative burden and loss of autonomy — that are burning out nearly two-thirds of all doctors. Otherwise, the status quo is sure to lead to a vicious cycle of more burned-out physicians, who are more likely to quit, leading to fewer doctors and more burnout.

Many health care organizations have already implemented changes to unburden doctors from patient messages, such as a team of staff dedicated to triaging all incoming patient messages. One organization has created an “inboxologist” role where one physician handles the inboxes of 10 physicians who have “surrendered” their inboxes. These team-based approaches can significantly reduce patient messages that a doctor needs to address, yet, it can feel like yet another “middleman” that interferes with the traditional doctor-patient relationship.

Artificial intelligence technologies integrated into electronic medical records can potentially reduce the time doctors spend on patient messages by pulling up information relevant to the patient’s concern and auto-drafting responses. This is already being rolled out in select large health systems across the country. I wonder though, whether this technology, while effective, will further degrade a patient’s trust in doctors when a patient must wonder if “It’s so good to hear from you” came from their doctor or an AI algorithm.

In the meantime, how can patients best use portals and messaging for medical care while minimizing their contribution to physician burnout?

Save the non-urgent questions for the next visit. Consider booking the next available appointment for nonurgent symptoms. Have a realistic expectation that your doctor may not get to you for a day or more and that another staff member may respond instead of your doctor. If you have urgent symptoms, it may be better to call and request to talk to someone, such as an on-call nurse. When you must message, keep the communication succinct and clearly state a request if you have one. If you are messaging to relay information helpful for your next visit, it also helps to clearly state that and that you do not expect a reply.

Finally, remember that doctors are also humans — at least for now.

Jason Bae is an urgent care physician practicing in Palo Alto.