The impact of doctor–patient interactions on patients’ service evaluations in online medical consultations (OMCs) has received considerable attention. However, prior research has mainly focused on the individual-level and statistical features of these interactions, with limited exploration of dyad-level dynamics in doctor–patient bidirectional communication. To address this gap, this study examines both individual-level and dyad-level features of online doctor–patient interactions to understand their effects on patients’ service evaluations. We characterize doctors’ individual-level communication behaviors using the quantity and informativeness of doctors’ information acquisition and provision, and capture dyad-level features by quantifying communication alignment in doctor–patient dialogues using spectral analysis. We utilize patient gratitude as an indicator of patients’ service evaluation. Drawing on expectancy violations theory, we develop a theoretical model to examine the direct and interaction effects of doctors’ communication behaviors and doctor–patient communication alignment on patient gratitude in OMCs. The model is empirically tested using a large dataset collected from a leading OMC platform in China. The analysis reveals three key findings. First, the informativeness of doctors’ information acquisition negatively affects patient gratitude, while neither the informativeness nor the quantity of information provision has a significant effect. Second, communication alignment positively influences patient gratitude. Third, communication alignment positively moderates the effects of the informativeness of both information acquisition and provision on patient gratitude. This study contributes to the literature on patients’ service evaluations, doctor–patient interactions, and communication alignment in online healthcare, and offers practical guidelines for enhancing the overall quality of online healthcare services.
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