CHPPC Module 24, Section 7: Email & Message Writing That Gets Action
MODULE 24: SPEAKING HOSPITAL: COMMUNICATION, CULTURE & POLITICS

Section 24.7: Email & Message Writing That Gets Action

Mastering the art of asynchronous communication to ensure your expertise is seen, understood, and acted upon in a sea of digital noise.

SECTION 24.7

Email/Message Writing That Gets Action

Learning to write with precision, brevity, and psychological acuity to become an effective digital communicator.

24.7.1 The “Why”: The Signal Through the Noise

In the 21st-century hospital, the Electronic Health Record (EHR) and its associated messaging systems have become the primary conduits for non-urgent communication. Every provider is inundated with a relentless stream of digital information: lab results, nursing notes, consult recommendations, and dozens upon dozens of messages from colleagues. This creates a state of chronic information overload and intense competition for a provider’s limited attention. In this environment, your ability to write a clear, concise, and actionable message is not just a matter of good manners; it is a critical determinant of your clinical effectiveness.

A poorly constructed message—one that is long, unstructured, and buries its key point—will be skimmed, misunderstood, or ignored entirely. This doesn’t happen because the recipient is negligent; it happens because they are human, and their brain is constantly triaging incoming signals, looking for the most urgent and most easily digestible pieces of information. A message that requires significant cognitive effort to decipher is a message that will fail.

This section is dedicated to the science and art of crafting messages that get action. We will teach you how to write with the recipient’s cognitive load in mind. You will learn to structure your emails and secure chats not as a stream of consciousness, but as a precision instrument designed to transmit a key piece of information, a clear assessment, and a simple call to action with maximum efficiency. By mastering these techniques, you will ensure that your clinical insights are not lost in the digital noise but are heard, respected, and translated into better care for your patients.

24.7.2 The Analogy: From a Casual Voicemail to a High-Priority Intelligence Brief

A Deep Dive into the Analogy

In your community pharmacy, leaving a message for a prescriber is like leaving a Detailed Voicemail for a business partner. You might call the office and say, “Hi, this is [Your Name] the pharmacist at [Your Pharmacy] calling for Dr. Smith regarding her patient, Jane Doe, date of birth 1/1/1950. I received a prescription for lisinopril 40 mg, but her insurance will only cover the 20 mg tablets. I was hoping you could either approve a quantity doubled for the 20 mg or send over a new prescription for a different, covered ACE inhibitor like quinapril. Please give me a call back at your convenience. My number is 555-1234. Thank you.” This is a perfectly appropriate and effective message for that environment. It’s polite, detailed, and asynchronous.

In the hospital, writing an email or secure chat to a busy physician is like authoring a High-Priority Intelligence Brief for a battlefield commander. The commander is in the middle of directing a complex operation and has seconds to spare for your report. Your brief cannot be a long narrative; it must be structured for immediate comprehension and action.

  • The Subject Line is the “TOP SECRET // URGENT” classification stamp. It must instantly tell the commander the topic and why they should open it. “SUBJECT: INTEL UPDATE – ENEMY TANK MOVEMENT – SECTOR 4.”
  • The First Sentence is the “Bottom Line Up Front” (BLUF). You lead with the conclusion. “BLUF: Enemy armored division approaching friendly position from the north; estimated contact in 15 minutes.”
  • The Body is the “Key Supporting Data.” You provide only the essential, verifiable facts that support your conclusion. “Source: Drone overhead imagery. Confirmed: T-72 tanks, 3 battalions.”
  • The Final Sentence is the “Recommended Action.” You propose a clear, simple next step. “RECOMMEND: Reposition anti-tank assets to Hill 405 and prepare for engagement.”

The commander can read and understand this entire brief in 15 seconds. It respects their reality, provides actionable intelligence, and gives them a clear decision point. This is the model for your digital communication in the hospital. This section will teach you how to write every message like an intelligence officer, not just a correspondent.

Masterclass Part 1: The Subject Line — Your First and Most Important Impression

The subject line is not a formality; it is the most powerful tool you have to get your message read. A busy clinician scans their inbox, making split-second decisions on what to open, what to ignore, and what to save for later. Your subject line is your only chance to influence that triage. A great subject line conveys the patient, the topic, and the general level of urgency at a glance.

The Universal Subject Line Formula

For 95% of your clinical messages, the most effective formula is a simple, three-part structure:

[Patient Name/Room #] – [Brief Topic] – [Urgency/Action Type]

This structure allows the recipient to immediately orient themselves and prioritize. They know who it’s about, what it’s about, and what you want from them before they even open the message.

Subject Line Showdown: Good vs. Bad

Scenario Ineffective Subject Line Effective Subject Line Why It’s Better
You are recommending a renal dose adjustment for a patient’s antibiotic. Question Jane Doe, Rm 602 – Vancomycin Dose Rec Immediately tells the provider the patient, the drug, and that a recommendation is inside. “Question” is useless for triage.
You need to clarify an ambiguous PRN order for pain medication. Med order John Smith, Rm 314 – Morphine Order Clarification Needed Specifies the drug and clearly states that an action (“Clarification Needed”) is required from the provider.
You are providing a non-urgent drug information response that the provider asked for earlier. Info Re: Your question on Drug X – Drug Info Response Reminds them of their previous question and signals that this is informational, not an urgent new problem. Can be read later.
You are notifying a provider that a drug they ordered is not on formulary and you are suggesting an alternative. Formulary issue Robert Chen, Rm 551 – Formulary Alt for Drug Y Needed Signals a problem (non-formulary) but also that a solution is required (“Alt Needed”). It’s actionable and clear.

Masterclass Part 2: The Ask-First Format (Bottom Line Up Front – BLUF)

This is the single most important principle of effective professional writing. Do not make your reader hunt for the purpose of your message. State your conclusion, your question, or your recommendation in the very first sentence. This respects their time and dramatically increases the likelihood that they will understand and respond to your core point.

The natural human tendency is to write chronologically—to build a case by laying out the background first, then the assessment, and finally the plan. You must train yourself to invert this structure. Lead with the plan.

Ineffective (Burying the Lead)

“Hi Dr. Smith,

I’m reviewing the chart for your patient Jane Doe in room 602. She was admitted two days ago for pneumonia and was started on IV vancomycin. Her baseline creatinine was 0.9. This morning’s labs show that her creatinine has increased to 1.8. Her vancomycin trough level also came back at 28, which is supratherapeutic. Given that her white blood cell count is improving, I was thinking we should make a change.”

(Problem: The provider has to read 80 words to figure out what you want.)

Effective (Ask-First / BLUF)

“Hi Dr. Smith,

For Jane Doe in room 602, I recommend we hold her vancomycin due to acute kidney injury and a trough of 28.

Her Cr has risen from 0.9 to 1.8 since starting the vanc. As an alternative for her pneumonia, I suggest we start ceftaroline. Would you like me to pend that order for you?”

(Benefit: The provider knows the entire situation and your recommendation within 20 seconds of opening the message.)

Masterclass Part 3: Templates for Action-Oriented Messages

Let’s combine the principles of a strong subject line and the ask-first format into a series of powerful, actionable templates for your daily work. Note how each one is designed for rapid comprehension.

Template 1: The IV-to-PO Switch Recommendation

SUBJECT: Susan Miller, Rm 204 – IV to PO Rec for Levaquin

Hi Dr. Davis,

For Susan Miller in 204, I recommend we switch her IV levofloxacin to the PO equivalent today to facilitate discharge.

She has been afebrile for >24h, her WBC is normalized, and she is tolerating a regular diet. The PO formulation has excellent bioavailability.

Is it okay if I make that change for you?

Template 2: The Non-Urgent Dose Adjustment

SUBJECT: Robert Jones, Rm 501 – Renal Dose Adj Needed for Lovenox

Hi Dr. Lee,

For Robert Jones in 501, I recommend adjusting his enoxaparin to the renal dose of 30mg daily due to a new AKI (Cr 2.3 today).

This will prevent drug accumulation and reduce bleed risk. The current dose is 40mg daily.

Please let me know if you agree, and I can pend the order. Thanks!

Template 3: Clarifying an Ambiguous Order

SUBJECT: Lisa Garcia, Rm 610 – Clarification needed for Ondansetron Order

Hi Dr. Wilson,

Could you please add a frequency (e.g., q6h prn) and indication (e.g., nausea) to the new ondansetron 4mg IV order for Lisa Garcia in 610?

The order is currently incomplete and cannot be acted on by nursing.

Thank you!

Template 4: The Formulary Interchange Recommendation

SUBJECT: David Green, Rm 811 – Formulary Alt Needed for Rosuvastatin

Hi Dr. Carter,

For David Green in 811, I recommend switching the newly ordered rosuvastatin to our formulary equivalent, atorvastatin 40mg daily.

Rosuvastatin is non-formulary at our institution. Atorvastatin 40mg is the therapeutically equivalent high-intensity statin and will provide the same clinical benefit for his ACS.

May I pend the order for atorvastatin for your signature?

Masterclass Part 4: Channel Selection and Common Pitfalls

Knowing what to write is only half the battle; you also need to know where to write it. Choosing the right communication channel—formal email vs. informal secure chat—is a matter of professional etiquette.

Use Secure Chat When… Use Email When…
The issue is a quick, routine clinical clarification that requires a reasonably fast (but not STAT) response. The communication is formal, requires detailed explanation, or needs to be sent to a large group of people (e.g., a departmental update).
You are communicating with the primary provider (e.g., the resident) who is actively managing the patient. You are communicating with someone outside the immediate care team (e.g., an administrator, a committee chair, an outpatient provider).
The conversation might require a brief back-and-forth. You are sending a final, detailed response (e.g., a drug information consult) that needs to be officially documented.
You are on a first-name basis with the recipient and have a collaborative relationship. The tone needs to be more formal and you are creating a permanent record that might be referenced later.
Digital Communication Pitfalls to Avoid at All Costs
  • The “Naked Hello”: Never, ever start a secure chat with just “Hi” or “Quick question” and then wait. State your entire purpose in the first message.
  • The Wall of Text: Keep your messages and emails short. Use paragraphs, bullet points, and bolding to break up text and make it scannable. If your message is longer than two short paragraphs, you should probably be having a phone conversation.
  • The Vague Ask: Don’t end a message with “Let me know your thoughts.” This creates work. End with a specific, yes/no question: “Is it okay if I make that change?”
  • The Accusatory Tone: Avoid phrases like “Your order is wrong” or “You forgot to…” Frame it collaboratively: “I have a question about the order…” or “For clarification on the order…” Always assume good intent. The goal is to solve the problem, not to assign blame.
  • Using “Reply All” Inappropriately: When responding to a group email, consciously decide if every single person on the original email needs to see your response. In most cases, they don’t.