Digital Empathy: Communicating Well Through Patient Portals and Secure Messages

The clinical encounter no longer ends when the patient leaves the room

A patient sees a laboratory result at 8:14 p.m.

At 8:17 they send a portal message:

“This value is marked abnormal. Is something wrong?”

Another patient writes because the medication prescribed yesterday is not available at the pharmacy.

Another sends six paragraphs describing symptoms that have changed since the visit.

Another replies simply:

“I don't understand.”

Secure messaging has become part of ordinary healthcare in many systems.

That creates an opportunity for better continuity.

It also creates a new clinical communication environment with different strengths, risks and expectations from a face-to-face encounter.

Empathy has to translate into that environment too.

An older promise has become a modern infrastructure problem

One of the sources in this collection, an early presentation about doctor-patient email, anticipated several benefits that now feel familiar: written instructions, educational links, fewer unnecessary visits, easier follow-up and a persistent record of communication.

The central idea was sound.

But ordinary email is no longer the most useful frame.

Modern patient communication increasingly occurs through secure messaging integrated with electronic health records and patient portals, where messages can become part of the clinical record and connect with results, prescriptions and appointments.

A 2026 scoping review examined 366 peer-reviewed studies of secure patient-provider messaging published between 2009 and 2025.

The literature generally supported benefits for patient engagement, care coordination and communication.

It also identified persistent problems: privacy concerns, inequitable access, inappropriate use, workflow problems and growing clinician workload.

Digital communication solved some old barriers.

It created new ones.

Text gives patients something spoken conversation often does not: time

In a consultation, information arrives quickly.

A patient may be processing a diagnosis while the clinician has already moved on to medication, prognosis and follow-up.

A written message can be reread.

A family member can help interpret it.

Instructions can be checked later rather than reconstructed from memory.

A patient can formulate a question without having to interrupt or remember it during a short appointment.

For straightforward communication, this is a major advantage.

Examples include:

• confirming the next step in an agreed plan;
• clarifying medication instructions;
• explaining a non-urgent result;
• sending preparation instructions;
• providing a link to reliable educational material;
• answering a bounded follow-up question.

Written communication creates persistence.

That is both its strength and its responsibility.

Text also removes information

In person, clinicians hear tone and pace.

They see facial expression, hesitation, breathlessness, confusion and physical deterioration.

A portal message flattens most of those cues into words on a screen.

“I'm feeling a bit worse” can represent a mild inconvenience or an evolving emergency.

The clinician may not know which from the sentence alone.

Digital empathy therefore includes recognizing the limits of the medium.

A message should become a telephone call, video consultation, urgent assessment or face-to-face visit when the clinical question cannot safely be answered through text.

The skill is not responding to everything digitally.

It is choosing the right channel.

Warmth becomes easier to lose in writing

Clinical messages are often written between other tasks.

That encourages efficiency:

“Labs normal. Continue meds. FU 3 months.”

The information may be technically sufficient.

The experience may not be.

A small amount of context can radically change the message:

“Your blood tests do not show the problem we were concerned about, which is reassuring. I know that doesn't explain all of your symptoms. Please continue the medication we discussed, and if the symptoms are not improving over the next two weeks, send us a message or arrange follow-up so we can reassess.”

The second version does several things.

It explains what “normal” means.

It avoids implying that unexplained symptoms are unimportant.

It tells the patient what to do next.

It provides a threshold for re-contact.

That is digital empathy in practical form.

A message should answer the emotional question when one is present

Patients do not always ask the question they most need answered directly.

“Is 12.4 very high?”

may mean:

Am I in danger?

“Can I wait until my appointment next month?”

may mean:

Do you think this could be serious?

A useful message responds to both layers when possible:

“That result is above the reference range, but at this level it is not an emergency. I would like us to discuss what may be causing it and whether we should repeat the test. Your appointment next week is appropriate unless you develop X or Y.”

The clinician has not added sentimental language.

They have reduced unnecessary uncertainty.

Clarity matters more than formality

Medical writing often becomes more technical than medical speech.

Portal messages can contain abbreviations, copied laboratory language and terminology that is obvious to clinicians but opaque to patients.

Digital empathy asks a simple question:

Could the intended reader understand what to do after reading this once?

Useful practices include:

• state the main conclusion early;
• explain abnormal results in context rather than repeating the number alone;
• use short paragraphs;
• avoid unnecessary abbreviations;
• distinguish what is known from what remains uncertain;
• give an explicit next step;
• state when and how the patient should seek more urgent help.

Plain language is not less professional.

It is more usable.

Boundaries are part of good digital care

Secure messaging creates access.

Access can quietly become an expectation of continuous availability.

Patients may not know whether messages are read instantly, once daily or only on working days.

They may not know whether a clinician expects one focused question or whether a long diagnostic history is appropriate.

Clinicians, meanwhile, can face a large volume of work that does not fit neatly into appointment schedules.

The recent secure-messaging literature repeatedly identifies clinician burden as a major challenge.

The answer is not simply to tell clinicians to write more warmly and work faster.

Systems need boundaries.

Patients should know:

• how quickly messages are usually reviewed;
• what kinds of issues are appropriate for messaging;
• what to do with urgent symptoms;
• when a message may lead to an appointment rather than an answer;
• and who on the team may respond.

Predictability is empathic because it prevents silence from being interpreted as abandonment.

Digital access is not equally distributed

Patient portals can increase access for people who find travel difficult, need written information or prefer asynchronous communication.

They can also exclude.

The secure-messaging literature identifies differences in use associated with digital access, socioeconomic factors, language, health literacy, disability and other patient characteristics.

A portal-first communication strategy can therefore unintentionally widen disparities.

Digital empathy means keeping alternative routes available.

A patient who cannot use the portal should not receive worse continuity because the system has decided that messaging is convenient.

Technology should increase options, not quietly redefine who is easy to care for.

The record changes the conversation

Secure messages often become part of the medical record.

That has advantages.

Advice is documented.

Questions can be revisited.

Other clinicians may see what has already been discussed.

But permanence also affects tone.

Messages should be written with the assumption that the patient may reread them later and that another member of the care team may need to understand them without additional context.

A dismissive sentence has a longer half-life in writing.

So does a clear and thoughtful one.

AI introduces a new question: who is speaking?

Digital communication is increasingly being assisted by artificial intelligence for tasks such as triage, summarization and drafting responses.

This may reduce workload and help clinicians produce clearer messages.

It also raises questions about transparency, accuracy, privacy, bias and responsibility.

The 2026 secure-messaging review identified AI-assisted messaging as a promising area but emphasized the need for governance and preservation of trust.

The essential principle is straightforward:

Automation can assist the communication. It does not remove clinical responsibility for the communication.

A fluent message that contains the wrong advice is still wrong.

An empathic-sounding message that fails to recognize urgency is still unsafe.

When should the message become a conversation?

Consider changing channels when:

• symptoms may require urgent assessment;
• the history is too complex to understand safely in fragments;
• significant bad news needs discussion;
• disagreement is escalating through repeated messages;
• the patient appears confused despite written clarification;
• sensitive information requires more contextual conversation;
• a large number of questions suggests that the underlying problem needs reassessment rather than another reply.

Moving away from text is not a failure of digital care.

It is competent use of the medium.

The central idea

Digital empathy is not adding a smiley face to a portal message.

It is communicating with the same clinical discipline we expect in person:

Understand the question.

Notice the concern behind it.

Use language the patient can understand.

State what happens next.

Be clear about uncertainty and urgency.

Respect the limits of the channel.

And create systems in which access for patients does not depend on unlimited invisible labour from clinicians.

The technology is new compared with the traditional consultation.

The underlying question is not:

How do we sound caring online?

It is:

How do we make written clinical communication clear, safe, responsive and human?

Selected evidence

Guo Y, Hu D, Zhou Y, et al. A scoping review of studies on secure messaging through patient portals: persistent challenges and potential solutions. npj Health Systems. 2026;3:34.

Johnson A, et al. A systematic review of the effectiveness of patient education through patient portals. JAMIA Open. 2023.

[Additional source context: the original uploaded presentation on doctor-patient email was used as historical inspiration; contemporary recommendations above are based on modern secure-messaging literature rather than its dated technical guidance.]