PCPs 50% more likely to have patients call them by first name in e-messages

Primary care physicians had 50% greater odds to be called by their first name in direct patient electronic messages compared with specialists, a recent study found.

Female physicians in particular were more likely to be called by their first name.

“Physicians are typically formally addressed as ‘Doctor’ by patients, acknowledging the physician-patient relationship, signifying respect for physicians, and following established social norms,” Jamison Harvey, MD, a dermatologist at Advanced Dermatology and Cosmetic Surgery in Arizona, and colleagues wrote in JAMA Network Open. “To our knowledge, this is the first study to objectively identify patterns of addressing physicians through electronic messaging and may reveal potential bias.”

The researchers reviewed 90,830 messages from 34,829 patients, spanning from Oct. 1, 2018, to Sept. 30, 2021, through the Mayo Clinic electronic medical record.

An integral part of the study was the utilization of an algorithm that helped to identify patterns of addressing physicians, which allowed the researchers to avoid would-be obstacles of analyzing patterns in a real-world setting, study coauthor Yul Yang, MD, PhD, a dermatologist at Mayo Clinic Hospital in Arizona, told Healio.

“Mutual respect and understanding are cornerstones of the physician-patient relationship — thus, a better understanding may result in better communication and patient outcomes,” Yang said. “Yet, objectively detecting any such bias is incredibly difficult in the real-world health care setting, due to patient confidentiality, changing behaviors if recorded or observed, resources required to analyzing hundreds to thousands of interactions, etc. With our natural language processing algorithm, we were able to evaluate over 90,000 patient messages, giving us a window into the physician-patient relationship at a large scale, in an organic, objective manner.”

Of the total messages, 29,498 (32.5%) from 14,958 patients included the physician’s name in the greeting or salutation.

Harvey and colleagues reported that female physicians (n = 1,092) had more than twice the odds of being called by their first name compared with men following several adjustments for patient gender and physician age, degree, level and specialty (OR = 2.15; 95% CI, 1.68-2.74).

Additionally, physicians with a DO degree had twice the odds of being called their first name (OR = 1.86; 95% CI, 1.2-2.88), while PCPs were 50% likelier to be called their first name (OR = 1.48; 95% CI, 1.16-1.89). Both findings were surprising, Yang said.

The researchers found that the majority of first-name messages came from male patients, as female patients were 40% less likely to address physicians by their first name (OR = 0.57; 95% CI, 0.5-0.65).

The study limitations that Harvey and colleagues noted include not knowing whether a physician preferred to be messaged informally; potential ethnic, racial and culture nuances of greetings; and the algorithm not identifying all greetings appropriately.

The researchers concluded that “untitling” may have a negative impact on physicians, and wrote that institutional leadership and individual efforts should focus on supportive work cultures.

“In the future, we hope to better understand the physician-patient relationship through electronic messaging, to determine factors that would encourage mutual respect and better patient outcomes,” Yang said.