Why don’t HCPs reply to pharma emails and messages?

Physicians reply to industry messages when three things are true: the sender is someone we already recognize, the message asks a question that belongs to the patient in front of us, and we can answer without leaving the thread we are in. Most pharmaceutical emails and texts miss at least one of the three, so they are deleted, very often unread. Physicians are not ignoring industry; we want engagement at our own pace, at our own time, and we want to initiate it. 

The clinic day has one reliable pocket of time, and it is not protected. It is the minute between closing one exam room door and opening the next, when most of us glance at our phones. That minute is now where the pharmaceutical industry tries to reach us. In my office there is still a stack of business cards from twenty or thirty pharmaceutical and medical device representatives, each one a person who once hoped for a few minutes of my day. Today those hopes arrive as emails and texts, and they all compete for that same crowded minute.

Most pharmaceutical emails and texts go unanswered because the few that matter arrive buried among the many that don’t. Colleagues will recognize the mix: sales pitches, recruiters offering a dream job in another state, and, nestled somewhere inside all of it, news about a new device or therapy that might genuinely matter to our patients. That last category loses twice. Either it is buried among the junk and never gets my attention, or I open it and find it is simply not a good way to learn about a therapy. 

We treat that pile the way we treat a favorite retailer who emails every holiday: by the fifth promotion, we unsubscribe. The same retailer, writing the week before a beach vacation about the swimwear we actually need, gets the click. 

The other pile is small, and it is the one I open first. It holds the follow-up from a representative I already know, the answer to a question I asked, the note whose subject line names a problem my patients actually have. My favorite kind follows up on something I started: I tell my medical assistant I would like to learn more about a product, and the representative sends exactly that, tailored to what I needed, to be read between patients or on an administrative day. Three properties separate the two piles.

A pharmaceutical message is far more likely to get a reply when it comes from a representative the physician already knows, because trust in medicine is earned over time, and it is earned by people. When a representative I know stops by on a packed clinic day, they will often text to let me know they are in the office, and I can usually text back within the day to set something up for later. A text from an unknown number, landing between two patients, gets a different reception. I find myself wondering who sent it and how they got my number, and the next patient is already waiting. 

A representative who is new to my office faces this through no fault of their own; everyone starts as a stranger. Often they leave a packet of information, stop by again later in the week and again the week after, and we still don’t connect. Both of us lose in that exchange, because it may be a very good therapy that I simply never hear about. What changes the outcome is whether that first contact gives me a reason to recognize the name the next time it appears. 

Physicians have a part to play here too. We are not always the best at getting back to people, and if we want to hear from industry on our own terms, some of the initiating has to come from us. 

The industry messages physicians open are the ones whose subject line speaks to the patients we are treating. The oath we took is actualized through evidence-based medicine, and the clinical obligations of a practice make keeping up with the literature nearly impossible to do alone. Training builds in protected time to learn; practice does not. So I learn in fragments: between patients, between cases, while I wait for the operating room, looking down at my phone. In that window I read subject lines and little else. 

The ones I open tell me at once that they fit my patient population, answer a question I have, or speak to a problem I am already seeing in clinic, such as a side effect that keeps coming up and a therapy that might address it. If it touches my patients, I will come back and read more on an administrative day. If it doesn’t, the phone goes back in my pocket and the next door opens. 

That is the whole test of relevance in medicine: whether the message helps the person I am about to treat.

Even a welcome pharmaceutical message asks something of the physician, and what it most often asks is a detour in order to answer it. For some representatives I text, for others I email, and for some companies my medical assistant calls a line that pages someone who calls us back later. I carry that directory in the Rolodex of my mind, and a question sent into it can feel like a note tied to a pigeon: I don’t know when it will come back. Meanwhile the patient calls again, my assistant asks again, and the whole exchange becomes a ping-pong effect that wastes everyone’s time. 

Who is accountable for that gap? Honestly, both sides. Even when a thread does exist, a small voice on my shoulder sometimes asks what we are permitted to discuss on it, and I suspect the representative on the other end is asking the same compliance question from their side. That uncertainty is structural. It is nobody’s bad faith. 

The messages I answer fastest make the reply part of the message. A representative once emailed me a link to their schedule for the next two weeks and asked me to pick a video or phone slot that worked. It started as an email and ended as a conversation, and neither of us had to leave the thread to get there.

Physicians and the pharmaceutical industry want the same thing from these messages, and it is better patient outcomes. A pharmaceutical company’s motive is the success of the company; a physician’s motive is the success of her patients. I respect the representatives who call on my office. They are the heartbeat of how we are able to do what we do. 

Medicine is one of the most advanced industries there is, yet our communication with the industry that supplies our therapies still runs on business cards, unanswered pages and, in some offices, the fax machine. That is a technological problem, and technological problems can be solved. 

For physicians, the fix begins with telling our representatives what our patients need. For industry, it begins with earning a name I recognize, writing about the patients I am treating, and making the reply as easy as reading the message. Patience and persistence will be required on both sides, and so will better tools. 

My hope is simple. I want every industry message on my phone to be one I invited, about a patient I am treating, that I can answer before I open the next door. 

About the author 

Dr. Mandira N. Mehra, MD, is a double board-certified neurologist and interventional pain physician and Chief Medical Officer at P360. She trained in neurology and interventional pain medicine at Thomas Jefferson University Hospitals, has practiced in Philadelphia, Wisconsin and the Washington DC area, and is the founder and host of Human Condition MD. 

About HCP Corner 

HCP Corner is P360’s physician series, in which practicing physicians write from their own point of view about how healthcare professionals and the life sciences industry communicate.