The survey assessed overall burnout by asking participants to self-report their level of burnout on a scale of 1 to 5, with 1 representing no symptoms of burnout and 5 representing completely burned out and possibly needing to ask for help. On this scale, researchers determined burnout as a score of three or higher. The confidential survey allowed linkage to EHR messages that were extracted during a yearlong period preceding their survey completion date. Researchers also extracted messaging types as classified in the EHR.

Overall, patient messages were mostly positive, with the most common words associated with positive messages being “thank,” “help,” “well,” “good,” “hope” and “care.” Among negative messages, the most common words included “cancel,” “pain,” “no,” “cancer,” “problem,” and “stop,” as well as expletives that were in the top 10 words used overall. 

The study found physicians who received a higher volume of messages had higher rates of burnout, though the difference was not significant, researchers said.

“There were no significant differences in the message sentiment score, proportion of positive messages, proportion of negative messages, or mean word count,” wrote first author Sally Baxter, MD, MSc, assistant professor of ophthalmology and biomedical informatics at the University of California San Diego, et al. “Approximately one-half of messages were positive in both groups, and only approximately 5% of messages received were classified as negative in both groups, with the remainder being neutral.”

While the association wasn’t strong, the findings did highlight the hostility toward physicians in many messages. That negativity could have other impacts on physicians, and the finding should be explored and noted by healthcare institutions. The complaints and negative sentiments in some of the messages should be further explored, the researchers noted.

“Analyses of high-frequency words included many expletives, demonstrating the animosity of some messages arriving at physicians’ inbaskets,” Baxter et al. wrote. “Some of these messages expressed negativity specifically directed toward physicians, while others expressed frustrations at the challenges of navigating complex healthcare systems or laments regarding clinical conditions. These messages could still be stressful for physicians, particularly if the patients’ frustration is related to factors beyond the individual physician’s control. However, these messages highlight the need for health systems to examine root causes of patient frustrations and improve patient engagement in their care.”