I recently received a package from Kaiser Permanente that showcases how an intended message can be undermined by content that’s too generic (and a little inconsistent). Here’s my response.
Dear Mr Permanente.
Can we talk about the materials you recently sent?
I received a screening and outreach package that included a letter from my physician, a page of screening recommendations, and a tri-fold brochure of wellness recommendations.
I get it. You insure and treat many kinds of patients. We speak different languages, have different insurance plans, different health needs — it is a complicated job to help us stay healthy.
You generally communicate pretty well, but I didn’t find this useful. I thought you might like to know more, and how your materials might accidentally undermine my confidence as your patient. See below. Hope it’s helpful…
Your friend,
C
Let’s break it down
Part 1: The letter from my doctor
“Dear Chris,
Working together, we can make sure you get the preventive care you need to help you stay healthy”
“There are several helpful tests Kaiser Permanente recommends for most people. To make sure you know what tests are due and when, we’ve included the following with this letter:”
I’m not sure what working together means, but I like that you’re going to tell me about the care I need to stay healthy.
Wait, now you’re talking about most people? Will it apply to me?
1. “A schedule of when you are due for preventive tests and labs based on Kaiser Permanente’s care recommendations. This schedule is based on our electronic medical records.”
You said you included a schedule, but nothing in this pack is labeled “schedule.”
What’s the difference between tests and labs? Is that important to me?
You said the medical records are yours. I think of them as mine. Is this going to be a problem someday?
You say the schedule is based on my records, so when I later see that the schedule is incorrect for me, I wonder why and I worry a little.
2. “A brochure about preventive care tests and labs so you know what to do now and in the future to stay healthy.”
I see a brochure called “Wellness recommendations.” It also says “Visits, tests, immunizations, and resources” on the front. Is that the brochure you mean?
“This schedule might not include other tests you should get because of your specific care needs. We can discuss any questions you have either before or during your next visit.”
If it does not reflect my specific care needs, how will it help me?
Does “before my next visit” mean in the waiting room prior to my being called back? Or does that mean in advance of me scheduling an appointment? I don’t have a next visit scheduled and you aren’t recommending one. Can I call with questions?
Part 2: "Screening, prevention, and wellness"
(I think this page is the “schedule” you mentioned, but it doesn’t say so and you didn’t mention this title in the letter.)
“Recommendations for Chris Barnes.
Tests completed in the last six weeks may not be reflected in this letter.”
The first thing you tell me is that your list may not be accurate or complete. Glad that I’ve not had any recent tests, but I wonder about other folks.
Is this a letter? I thought it was the schedule.
“Due in one year or more.
Due 2025. Colonoscopy… screening due every 10 years unless you are on a more frequent schedule. If you are not on a more frequent schedule, annual stool tests may be an option instead. Please contact me before your due date. Last colonoscopy was on [date].”
Good to plan ahead I guess, but “one year or more” is not very practical. Will you remind me again, or is this the last notice I get before 2025?
Do you expect people to remember whether they are on a more frequent schedule? Assuming you know what my status is, why not just tell me?
“Contact me”? Who should I contact? Is this page also from my doctor? It looks different and doesn’t say.
Last colonoscopy… Yes! Thanks for pulling my actual data from your system.
“These reminders are based on general recommendations. If you are on a special schedule, please follow that schedule. If you have questions, or think you no longer need a test, please call the Screening Information Line at [number].”
Another reminder that the information may not apply to me.
What’s the screening information line? So this isn’t from my doctor? Can I call my doctor?
Part 3 (the brochure): "Wellness recommendations — men 18 to 64"
“Wellness recommendations” sounds like it should include some advice about lifestyle (exercise, diet, stress management). It doesn’t.
“For men 18 to 64.” You know how old I am, right? That’s a pretty broad range.
There are nine items listed in my age range, but the “schedule” page only listed a colonoscopy. Do the other eight items apply to me? Do I need to do anything?
There are a lot of footnotes (16 out of 29 bullets refer to five different notes that are presented on two different pages). Based on the age range, many of us will need glasses to read that information.
You remind me several times that the information may not apply to me and that I should talk to my “health care team” if I have questions. You didn’t mention a team anywhere else, is that different than my doctor?
You might consider a few changes
Consolidate terms to reduce potential confusion
Across the three pages I see too many different terms all getting at the same idea. Using just a few phrases would help reduce confusion and streamline translation.
Choose one of: “wellness recommendations”, “routine care recommendations”, or “care recommendations”
Choose one of: “well care”, “preventive care”, “preventive tests and labs”, or “screening, prevention, and wellness”
Choose between “health care team” and “doctor” unless they are different
Get personal
You have my data. If you use it effectively and appropriately when communicating with me, you tell me that:
you want to be helpful
you respect my time and you try not to waste it
you respect my privacy by being intentional about what, how, and when you talk about my health information
your electronic data systems work well
you see me as an individual
Make content less generic to make it more valued
The content of this screening outreach appears to be cobbled together from different systems: it’s inconsistent in terminology, tone, information, and is painfully generic.
I doubt this communications effort saw much user input so I’ve offered mine. Take it with a grain of salt because I’m just one older dude lucky enough to have few health concerns. You have so many different kinds of patients that need to be served. Making the content generic is not the answer. Making it more targeted and patient-specific will make it more useful, and THAT should be the goal.
What I want: the short list
Address me personally and tell me why I’m receiving this letter.
Summarize your recommendations and what I need to do (if anything) right away.
Include data from my records that supports those recommendations to (a) remind me of the care I’ve received and (b) show me that your recommendations are based on my specific needs.
Tell me what your recommendations will cost me. If you can’t, be direct about it and think about throwing in an apology.
I re-wrote this version for you…
Hi Chris.
I’m your doctor at Kaiser Permanente and I’m writing to tell you about the preventive care we recommended for men your age.
More information is on the enclosed sheet labeled “Preventive Care Recommendations & Schedule,” but here’s a summary of what our guidelines suggest you need:
Your preventive care is up to date. No visits or tests are needed at this time.
VISITS
My records show that you are now over 50 and the last time you saw someone at Kaiser Permanente for a well visit was [date]. I don’t need to see you for a well visit this year, but I do suggest that you schedule a well visit next year. I’ll send you a reminder when the time gets closer.
TESTS
At your age you should have a colonoscopy test once every ten years. You had one in 2015. Based on the results, I recommend that you have the test again in [recommended year].
QUESTIONS?
Use the KP app or visit [website] to see customized care and lifestyle recommendations for you, schedule an appointment, look at your visit and test history, or to send me a private email message. You can also call [phone].
I’m sorry that as your doctor I don’t have information about your health insurance plan and benefits — crazy, right? we’re working to fix that — but you can always call [phone numbers] or check your plan online [here].
Stay well,
Doc
PS. If you want to receive care reminders on your phone or computer instead of in the mail, you can tell us your preference at [online] or [phone].
I don’t mean to pick on Kaiser Permanente, by the way. Many health groups send similarly non-specific information. So do banks, school districts, large employers — organizations with large complex systems, diverse audiences, and technical inertia. But it never feels good, right?