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The Stapled Christmas Letter Problem: Email and Newsletters That Get Read
Most practice newsletters read like the three-page holiday letter everyone skims and recycles. Members don't want generic health tips they can find anywhere. They want to hear from their doctor, about their community, in five words that matter.
Start here: the questions this brief answers
Tap a question for the short answer, then jump to the evidence.
A generic health newsletter is the medical version of the stapled three-page Christmas letter: well meant, rarely read. CMT's No More Waiting Rooms argues members want something personal, local and useful, in the words "Five words from you mean more to me than fifty words about you." Keep the rules in view. Under HIPAA, communications describing your own services or made for treatment and care coordination generally fall outside the definition of marketing, but using patient information to promote other products or services generally requires written authorization. Commercial email must follow the CAN-SPAM Act, including a clear opt-out honored within 10 business days and a physical postal address. Send less, make it personal, and make every issue worth opening.
“If your newsletter could have been sent by any practice in America, it shouldn't be sent by yours. Write it like a note to a friend from their doctor, because that's what your members are paying for.”
Why don't members read our newsletter?
Usually because it's generic: health tips anyone can find online, with no personal or local voice. No More Waiting Rooms calls it the stapled Christmas letter.
Go to the full answer ↓What should a practice email include?
A short personal note from the physician, one useful local or seasonal item, practice news members need, and one clear action. Part 3 has a template.
Go to the full answer ↓Does HIPAA restrict practice emails?
Describing your own services or communicating for treatment generally isn't "marketing" under HIPAA, but promoting other products using patient information generally requires authorization. Check with your compliance adviser.
Go to the full answer ↓What does CAN-SPAM require?
For commercial email: accurate sender information, honest subject lines, a physical postal address, and a clear opt-out honored within 10 business days.
Go to the full answer ↓The stapled Christmas letter
You know the one. Three pages, stapled, every December, from that one family. You skim it. You recycle it.
Michael Tetreault says that’s exactly how many patients file their doctor’s newsletter. Generic links, cold-and-flu facts, educational excerpts “we can find anywhere on Google in a few seconds.” Not specific enough, no clear action steps, and, he admits it’s harsh, “a big waste of my time as your Patient.”1
His alternative is simple: get small and personal.
Five words from you mean more to me than fifty words about you.
From No More Waiting Rooms (2024).1
Two sets of rules to know
HIPAA
HHS defines marketing as “a communication about a product or service that encourages recipients of the communication” to buy or use it. Communications describing a covered entity’s own health-related products or services, or made for treatment or care coordination, fall outside that definition. Marketing that uses patient information generally requires the patient’s written authorization, and authorization must mention it if a third party is paying.2 Policy and Law
Practical read: news about your own practice and seasonal reminders to your members are usually fine. Promoting a partner’s products to your patient list, especially if they pay you, is where you need your compliance adviser.
CAN-SPAM
For commercial email, the CAN-SPAM Act requires accurate sender information, subject lines that reflect the content, a valid physical postal address, a clear way to opt out, and honoring opt-outs within 10 business days. You can’t contract away responsibility if a vendor sends for you.3 Policy and Law
Group emails should never reveal who your patients are. Use blind copy or an email platform, and keep individual health information out of newsletters. Ask your compliance adviser about secure messaging for anything personal.
A newsletter members actually open
| Section | What it looks like | Length |
|---|---|---|
| A note from your doctor | What's on their mind this month, in their own voice | 3 to 5 sentences |
| One useful local thing | Flu shot clinic dates, a local trail reopening, a community event you're part of | 2 sentences |
| Practice news | A new team member with a photo, changed hours, how to reach someone after hours | Short list |
| One action | Book your annual visit, join a walk, reply with a question | 1 line |
CMT original template. Evidence type: Practice Insight.
Skip anything a patient could find with a search. Write like a person. Send less often if that’s what it takes to make every issue worth opening.
Make every email worth opening
- Read your last newsletter out loud. Would you open it?
- Have your physician write a five-sentence note for the next issue.
- Confirm your email footer has a physical address and an opt-out link that works.
Your newsletter is a community tool. Plan the local events and partners worth featuring.
Free. No sign-up. Your answers stay in your browser. Step 3 of CMT's Learn, Build, Lead tools. It helps you pick the patient segments that fit your practice, find where they are, plan conversations with local physicians, check that your message sounds like care rather than a pitch, and leave with a 90-day plan.
This brief is educational and is not legal advice. HIPAA, CAN-SPAM, state privacy laws and platform rules may apply to practice email. Consult a qualified adviser.
Not a Christmas letter
Generic gets skimmed and recycled.
Small and personal
A note from your doctor beats fifty health tips.
Follow the rules
HIPAA marketing and CAN-SPAM basics.
How this brief was built
This brief draws on HHS Office for Civil Rights guidance on HIPAA and marketing, a university summary of FTC CAN-SPAM guidance, and CMT's No More Waiting Rooms (2024). The newsletter template is CMT original guidance. Legal summaries are general; email practices involving patient information should be reviewed by a compliance adviser.
How to read the evidence types
Every key finding is labeled by evidence type. Labels describe the type of evidence, not its value. Each type answers different questions. Funding is disclosed on every source.
Randomized trials and systematic reviews.Best for cause and effect.
Large observational studies and government data.Best for trends at scale.
Surveys, smaller studies and expert consensus.Best for real-world experience.
Company-sponsored or company-reported data that is not peer-reviewed.Best for early signals and operating data.
Statutes, regulation and official guidance.Best for what is required.
What we don't know
- Open and click rates for membership practice newsletters; no published benchmark was found.
- Whether email frequency affects retention in membership practices.
How to cite this brief
External review: this brief has not yet been reviewed by an outside expert. When review is complete, the reviewer is credited by name above with any conflicts of interest, and the version number is updated. Reviewers check accuracy and fairness; CMT is responsible for the final content.
Corrections policy: when an error is identified, CMT corrects it in the open and updates the version number above. Send corrections to the editor through conciergemedicinetoday.net.
Related CMT Research Briefs
References
- Tetreault M. No More Waiting Rooms: A Customer Service Road Map to Help Remarkable Medical Offices Navigate Their Way Towards an Irresistible Practice Where Gratitude Is on Repeat. Concierge Medicine Today, LLC; 2024. Stories are the author's own experiences and accounts told to the author.Funding: Concierge Medicine Today (self-published; no outside funder) CMT original
- U.S. Department of Health and Human Services, Office for Civil Rights. HIPAA Privacy Rule guidance: Marketing. Guidance dated 2002, revised 2003; last reviewed 2013. www.hhs.govFunding: federal (U.S. Department of Health and Human Services publication)
- Youngstown State University IT Security Services. The CAN-SPAM Act: a compliance guide for business (summary of FTC guidance). Accessed October 2026. ysu.eduFunding: not stated (university IT summary of federal guidance)
Educational and informational only. This CMT Research Brief does not constitute medical, legal, tax, financial, accounting or other professional advice, and it does not create a professional relationship of any kind. Statements about laws, regulations, tax rules and payer policies are general, may not reflect the rules in your state, and can change after publication. Consult a qualified attorney, accountant, tax adviser, compliance professional or licensed clinician before acting on anything here.
Independence. Concierge Medicine Today is an independent publication. It does not accept payment for favorable coverage, and it does not favor one practice model over another. Company names and products are mentioned for context only and are not endorsements. Funding is disclosed for every source in the reference list.
Accuracy. CMT verifies figures against their original or best available sources at the time of publication. Where a figure is an estimate, an inference or a company-reported number, the brief says so. This content is not without possible error or omission.
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