How To (Properly) Text Patients

I basically only get three types of texts.

• Either it’s my parents asking for something really specific followed up with “ok”.
• It’s my friends sending a funny tweet I saw 1 week ago but still “haha” react out of politeness.
• Or it’s my doctor’s office asking if I’d be willing to fill out a short feedback survey, which I know no one will ever look at.

For all the talk of telemedicine taking over healthcare, no one really teaches you how to do it well. This is especially true of texting, which is a core part of a good telemedicine relationship.

Today I have a guest post from Dr. Ajay Haryani who’s worked in different telemedicine contexts and had some very wise words to share with us about how to text properly. I added some flair/memes to the post.

By the way, texting is really only one tool when it comes to building a patient experience. We go through how this interacts with your call center in our upcoming “Healthcare Call Center” course.

​Sign up here, enrollment ends this week.

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Effective Strategies For Texting Patients, From Dr. Ajay Haryani

Almost every healthcare company leverages SMS in some capacity.

Of course we know the painful classics:

• YOUR APPOINTMENT WITH DR. KRISHNAN (he wishes) IS IN 1 HOUR.
• ON A SCALE OF 1-10, HOW WOULD YOU RATE YOUR SUPPORT.
• YOU HAVE A NEW MESSAGE, CHECK YOUR APP (requires an update)

But SMS, when executed with intention, can become your most powerful tool. It’s accessible, preferred, and empowering - really “The People’s” comms channel.”

Throughout my time building and scaling a primary care model for Medicaid and Medicare, I’ve leaned on SMS to drive clinical engagement, patient retention, and behavior change across urban and rural populations and across age groups (Yes - Medicare patients text!). In the case of marginalized populations, it’s even unlocked life-changing care that otherwise couldn’t have happened due to structural barriers to care.

While SMS lowers the barrier to communication, the execution is easy to fumble. There is that much more noise to break through in establishing your legitimacy and establishing SMS as a channel for care.

We want to share with you the most impactful, “need-to-have” components you need to think through when executing your SMS strategy. These are the pillars upon which to build your processes, audit your current platform, and take your texts from a source of alert fatigue to creating dialogue and engagement.

We’ll take you through:

The Prep - setting yourself up for success

The Text - content of the message

and Regrets - mistakes I’ve made that you should avoid

Part 1: The Prep (aka contextual factors that support building connection over SMS).

How to not be spam

It doesn’t matter what your text message says if no one reads it. Most SMS strategies have terrible yield because they don’t break through this first barrier: differentiating from the myriad of random texts that our patients receive. They don’t know who you are.

1) Explicitly tell them that your organizations will use SMS to communicate with them. SMS is still relatively new in healthcare; patients are expecting phone calls and faxes. This is a necessary expectation to set with them early on.

2) Taking this one step further,do everything you can to prime the text message (i.e. cognitively tie the messages to synchronous human interactions).

Example finishing a phone call: "As a heads up, one of the ways that we communicate with our patients is by text. I use this for check-ins to see how you are doing, to let you know about upcoming appointments, and other items related to your health. I'll send you a text later this week to follow-up! And if you ever have any questions, we have a team of people monitoring our texts so you can just shoot us a message at this same number that we're talking on today."

3) Call and text from the same phone number. If you can mask as a more trusted provider (let’s say the PCP’s office), even better. Shout-out to Douglas Streat and the Aledade team for highlighting this tactic, especially powerful for those of you in the “enablement” space where you may not be the most familiar name to the patient.

• “Save this contact” during the first interaction. While you are enrolling a new patient, take the extra time to walk through adding the contact together. This can be done in person, over the phone or however you enroll.
• When I do initial visits with patients, I make sure our main line is saved in their phones as “Organization Name - My name” and do a test call live with them from that number. It’s a moment of teaching that will stick and make them more likely to use and recognize it.

Timing is critical to relationship building

Responsiveness (i.e. the ability to respond within a specific timeframe) and reactivity (the ability to change your responses based on what the patient says) are both crucial factors in the “How natural does this feel?” calculation for your patients.

1) Text when humans would normally text.

My best response rates were early AM immediately before work hours and after doomscrolling or at the end of day / immediately after work hours and doomscrolling. Weekend texting can be powerful and can convey a sense of “24/7 care”, but be careful - most patients have a negative reaction to blasts, logistical asks, or anything that feels robotic on the weekend. The vibe can quickly switch from “I feel cared about” to “I feel imposed upon”.

2) “Faster isn’t always better” - this is good advice for…lots of things

Immediate (within a few seconds) responses always feel robotic, no matter what. If you are doing auto-responses that you want to appear human, trigger them after a few minutes.

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In building connection, response speed is important, but the depth and usefulness of your response is equally (if not more) important in establishing SMS as a reliable channel for the patient.

• For example, if you have swift responses with the words “Thank you so much for your concern! We will pass this along to your team” but don’t ever actually answer the patients’ questions or solve their problems, you are training your patients that your SMS channel is just an answering service and they will stop reaching out with needs.
• One practical tip here is to empower your frontline staff who are monitoring the text queues to be as full-service as they can. Provide them with the answers to the most likely questions that patients will ask (for example - the date of the next appointment).
• Even when your text-monitoring staff has to tap in others for answers, get in the habit of solving the problems over SMS unless a phone call or in-person visit is truly needed. It will reinforce the channel as a place of care.

Part 2: The Text

Your SMS messages are extremely high real-estate - every character counts. These are my primary considerations in nailing the content of the text message.

1) Names are important
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​Scenario #1: Cold outreach and you’ve never met them:
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In my experience, it’s a safer bet to use Mr/Ms (last name) than to accidentally use their formal first name that no one ever calls them by. If my patient’s name is Theodore Brown (who likely goes by Ted or Teddy) - Hi Mr. Brown >>> Hi Theodore. The latter really gives “I’m a robot pulling names from a spreadsheet”. The former also gives “I’m pulling names from a spreadsheet, but at least they’re not assuming they know me.”
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In general, I think using a name is better than not.
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Scenario #2: Warm follow-up and you’ve met them before
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Track how your patients prefer to be addressed as a separate variable from their First or Last name - and use it! This is an immediate win and establishes yourself as familiar.

2) Nail the intro statement

The first sentence of your text is what shows up on the “Preview” for most phones. This is a make-or-break moment where the patient will make a split-second decision on whether this message is important or trash.

Quickly establish yourself in association to the most familiar name in the patient’s life, depending on your care model. If the patients in your organization are closest to the community health workers, use their name. Same for PCP.
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If relevant, open by referencing a prior touchpoint.

For example: “Hi Mr. Brown. This is Danielle from Dr. Haryani’s team, reaching out to follow up on your medications like he had discussed during your appointment on Tuesday.”

3) If you can create dialogue, you’ve won.
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So - if your ops can handle it - start by asking questions that are super low threshold to answer, even if it’s not the question you need answered. Once someone responds once, they are much more likely to respond again, and this encourages more of a “relationship” feel than a transactional one.

4) Thoughts on “empathy”

You can’t google patient communication best practices without coming across this word. But if you’re googling “empathy” we have a very different place we need to start.

In the era of chatbot customer service, generic empathic statements over text have been exhausted. Automatically receiving a message that says “I’m sorry to hear that” after you express a concern does not work to further the relationship, and at worst, it feels fake, inauthentic, and empty.

My recommendation here is to tread carefully. You can use classic empathy statements (naming emotions, conveying support or sympathy, etc), but when you do, keep them casual and within the context of an established dialogue. It’s okay to be a little extra (add emotional cues to the message via emphasizing words or punctuation in order to humanize them)

Examples:

• The difference between “I’m sorry to hear that” and “Oh no! I’m so sorry that you had to wait at the radiology center for three hours!” is significant in terms of which feels like a canned response vs. a human demonstrating care.
• For more positive emotions, you can contrast “Thank you for letting us know” with “Wow! That’s great news! I’ll let Dr. Haryani know to discuss at your next appointment”

Part 3: Regrets

Learn from my mistakes! Please!

1) Two different people respond to the patient at the same time

On the patient end, receiving two different responses in succession feels extremely disjointed and awkward. It disrupts the relationship and is depersonalizing. If you have multiple people monitoring an SMS queue, you must have clear processes around who is owning which messages. If your vendor doesn’t concretely have a way of demonstrating ownership, then your processes need to be that much tighter.

2) Scheduling a blast when you aren’t staffed to respond

As mentioned above, creating dialogue is a key component of developing your SMS channel. If you send a message at 5PM but no one is monitoring the text queues until the next morning, you’ve missed the opportunity to create a back-and-forth that feels natural and is necessary as you build the virtual care relationship.

3) Not playing the long game

The beauty of SMS is that it's efficient and it intentionally unlocks time on the part of the patient to respond. Think of it more like a friend who you keep in touch with by text every once in a while but neither of you are really “on top of it”. This is how you will be treated (at best).

4) Being too aggressive to force a decision

This is the classic CVS text. It’s not the frequency that frustrates people - it’s the fact that it feels like they are putting a gun to your head every time they text you. The forced choice architecture here (ARE YOU COMING TODAY, TOMORROW, OR ARE YOU DEAD?) is the pain.

Conclusion - Nikhil’s footnote

If you replaced every instance of patient with “person you’re flirting with” it’s still great advice.

More seriously, a lot of companies that want to build telemedicine-first workflows think of texting as a way to just blast out information vs. a way to actually build a relationship. It’s also not easy - you need to be thinking about what your text-based relationship looks like even before you’re actually texting.

Another aspect of this is how you also empower the teams around the clinician who might be able to assist with non-clinical questions. In the call center course, we actually have a workshop focused on how to use GPT to create script assistants that you can use to help agents answer questions.

How was that for a segue? Wait what do you mean it wasn’t good?

Thinksquad out,

Nikhil and Ajay aka. “Two very different pre-med outcomes”

P.S. You can reach out to Ajay to chat more at ajayharyani@gmail.com or via Twitter / LinkedIn. He’s excited to help organizations across the spectrum think through building meaningful care relationships.

Thanks to Danielle Poreh who did a lot of the coaching and editing for this. Also she teaches the call center course!

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