Mind your manners—or don’t: exploring how patient politeness influences physician response quality in online health communities

Politeness plays a central role in online health communication, yet its consequences for physicians’ service quality remain insufficiently understood. Drawing on social exchange theory, this study examines how patients’ linguistic politeness and impoliteness influence physicians’ informational and emotional support in a large Chinese online health community. Using computational text analysis and econometric modeling, we analyze physician–patient interactions at the consultation level. Results show that patients’ politeness is positively associated with both informational and emotional support. Interestingly, moderate levels of impoliteness are also associated with increased physician effort, suggesting compensatory responses to emotionally charged requests. Moreover, patients’ politeness exhibits spillover effects, shaping physicians’ service provision to other patients within the same time frame. By distinguishing between politeness and impoliteness and identifying both direct and cross-patient effects, this study extends research on language use in digital healthcare and highlights the relational dynamics underlying service quality in online professional communities.