A New, Better Way to Use Your Patient Emails


How to leverage email for better engagement and retention

By Heather Chavin, MA*

Most practices, large or small, collect patient emails. They use them for patient paperwork, introducing patients to seldom-used patient portals,1 and for sending the occasional newsletter.

We email patients asking them to make our lives better. What if we emailed them to make their lives better?


We know that most patients are not successful with their home programs. Only about 35% adhere to their full program, citing challenges such as barriers (perceived or actual), a lack of reinforcing positive feedback, and lower levels of self-efficacy.2 This doesn’t include the patients who show for one visit and never come back.

When you think about a home program as a prescription, this seems baffling. Why wouldn’t you do the thing that is supposed to make you feel better?

Having been a mental health therapist, it’s clear to me that most home programs are not simple prescriptions, but a request to patients to make a behavior change, to start a new habit. A challenging habit at that. When was the last time you hit all of your exercise goals? And you’re a physical therapist.

If we reframe home programs from a prescription to longer-term behavior change and habit adoption, challenges like barriers, positive feedback and self-efficacy begin to make sense. It also makes sense why patients who have failed to adhere might want to protect their egos by minimizing the importance of the program, lying about how much of it they did, or worst of all, not showing up.

Physical therapists are not mental health therapists. There are only so many minutes in a visit and hours in a day. How can you help patients overcome barriers and build the skills required to get them engaged and coming back feeling proud of themselves?

You can use their email.


Most email systems have automation as an option. You can set up a chain of pre-written emails and as soon as a new name is added, it kicks off the emails at an interval of your choosing. Let the patient know that they’ll be getting a series of short emails to help teach them strategies to make therapy more effective and their home program easier to plan for.

Here’s what a sample series might look like:

Day 1: Positively reinforce their decision to engage in therapy and normalize the challenge of adopting a new habit. Frame even partial adherence as a success to boost self-efficacy.

Day 2: List common barriers and possible solutions. Provide several short (single paragraph) success stories of other patients who overcame challenges.

Day 3: Positively reinforce their continued engagement even if it’s just reading the email. Give them suggestions of what to do if they’re struggling and reinforcement if they’re succeeding.

Day 4: Provide another set of suggestions and short success stories for more social proof and encouragement.

Day 5: Acknowledge the dip. The newness is wearing off and life is getting in the way. Give them tips for staying consistent, remembering their goal to boost motivation, and remind them that they’ll be meeting with you again soon for a sense of accountability.

Day 6: Encourage reflection on what has been working and what has been challenging. Normalize the struggles again. Encourage them to bring it up with their therapist.

Day 7: Congratulate them on making it for a whole week and remind them that even if they haven’t completed all of their exercises, they’ve learned something about themselves and are better equipped to tackle in week two. Let them know that the emails will start coming less often.

The email cadence can continue with decreasing frequency. Since it takes closer to 66 days to create a habit,3 consider a full two months shifting the content towards building on successes, maintenance, and building the self-efficacy needed for discharge.


Keep the emails simple and positive and the tips highly practical. If you’re struggling to build the content, you can pull the tips directly from one or more of the following books:

  • The Willpower Instinct by Kelly McGonigal
  • Atomic Habits by James Clear
  • Better than Before by Gretchen Rubin

All of the books translate the research to be digestible to the layperson and are incredibly practical.

We ask a lot of our patients. We’re often asking it while they’re scared and in pain. With a very scalable automated email system, you can offer them support and encouragement, which in turn will help keep them engaged, improving and spreading the word. 


1Hoogenbosch B, Postma J, de Man-van Ginkel JM, Tiemessen NA, van Delden JJ, van Os-Medendorp H. Use and the Users of a Patient Portal: Cross-Sectional Study. J Med Internet Res. 2018;20(9):e262.

2Sluijs EM, Kok GJ, van der Zee J. Correlates of exercise compliance in physical therapy. Phys Ther. 1993;73(11):771-786.

3Lally P, van Jaarsveld CHM, Potts HWW, Wardle J. How are habits formed: Modelling habit formation in the real world. Eur J Soc Psychol. 2010;40:998-1009.

Heather Chavin

Heather Chavin, MA, is a PPS Administrators’ Network Member, business and productivity coach, and freelance writer in Eugene, Oregon. She can be reached at heatherchavin@gmail.com or www.linkedin.com/in/heatherchavin/.

*The author has a professional affiliation with this subject.

Editors Note: The article “A New, Better Way to Use Your Patient Emails” in the September 2020 issue of Impact covered an innovative marketing use of patient emails. It is important to note that, without a HIPAA disclaimer, this marketing tactic may pose a risk for practices. The use of a patient list across the open internet may expose PHI (the patient’s name and/or email address) in a nonsecure manner (i.e., not encrypted), which would be a HIPAA violation without first receiving the patient’s explicit permission to send information via email without protection, per the Security Rule. Impact thanks Mary R. Daulong, PT, for her insight on this important step.

Copyright © 2018, Private Practice Section of the American Physical Therapy Association. All Rights Reserved.

Are you a PPS Member?
Please sign in to access site.
Enter Site!