Should a patient portal be an ad-free space? Should anything?

I was surprised to get a promotional message in my doctor’s patient portal, mislabelled as “New Information in Your Chart.” It made me think about marketing, what it is, and where it belongs.

Here’s how it looked:

I like my doctor and I like my doctor’s practice, which I think is doing excellent work. I’m also pleased they’re offering relationship counseling. Even so, I was royally pissed off about seeing this message in the patient portal. Since I get so many marketing messages, I had to ask myself: what was bothering me so much?

Here’s a short list:

  • I don’t expect ads in a patient portal. I expect nothing but health-related information specific to me. I want my test results. I don’t mind appointment reminders. I’m open to billing. But don’t try to sell me things.
  • It’s mislabelled. This was the biggest annoyance: it’s labelled as “New Information in your chart.” My doctor confirmed that this wasn’t their intention. But I suspect that the hospital group that provides the portal does not include an “advertising something you should pay for” setting in the messaging interface. (Why not? Hmm.) Somebody in that medical office had a pull-down list and didn’t see “marketing services” so they had to pick another choice. They ended up with “Information in your chart.” But the result is that the message appears to me as if it were something like a test result. Nobody likes a bait and switch. (Imagine if I were actually awaiting a test result, like a diabetes test or a cancer diagnosis, and I got this message and opened it up. That would be beyond cruel.)
  • It’s not really from Sarah, the MA. I don’t recall meeting with Sarah; she’s not my doctor or medical assistant. They’re just using her name. It should be from the practice — but then I might not open it.
  • It violates trust. The medical relationship is based solidly on trust. Trust means I pay you and you help me with health problems based on your expertise. Marketing in the patient portal undermines that trust.
  • It’s not targeted. I’m betting they sent this to everybody, most likely including single people and people who are being treated for injuries from abusive spouses. (If in fact they did send it only to patients who are married or in relationships, that raises another question: why are they using my personal relationship information for targeting purposes?)
  • I can’t unsubscribe. Any other marketing message includes an unsubscribe option. This one doesn’t, because you really don’t want to unsubscribe from messages from your doctor — and this messaging system can’t distinguish between marketing messages and essential medical information.

When I contacted my doctor, he said that several people were pleased to receive this message and had gratefully signed up for counseling. What he couldn’t say, though, is how many people just grumbled about receiving marketing messages in their patient portal and didn’t respond. Spam is only spam if you’re not interested.

Was it worth it? Since doctors don’t do much marketing, they don’t think this way. But everyone who advertises anything thinks that annoying thousands of people in exchange for reaching a few who are actually interested is worth it. We all accept that the annoying car ads on television are the price we pay for watching the program — except for the few people who are in the market for a car at that moment, who might scrutinize the ad carefully for deals.

When you watch TV, you make that bargain implicitly. But when you go to the doctor, you don’t expect to have to think that way.

Where does marketing belong?

From the doctor’s perspective, helping a few people at the price of annoying a lot is worth it: “See, we’re providing a service people want.” But that’s exactly the same bargain every marketer makes. And there are limits. Messaging your customers’ email three times a day is too much, for example, even if some might find what you’re selling useful. The medical office has to figure out where the line is for their patients — and in a medical setting, in my opinion, that line ought to be set very close to zero.

Advertising has now infiltrated so many spaces, with more appearing every day. It’s on the turnstiles in the subway, on the messaging system from the social media app, in my text messages. There’s a principle at work here: if you pay attention to something, ads will go there. And if it’s now ad-free, it’s fertile ground, because unexpected ads in virgin territory will get even more attention.

That means that we, as a society, need to draw the line, because if we don’t, ads will get into spaces where they don’t belong, like my patient portal. And we, as marketers, need to agree on rules like this as well, because once we start to infiltrate these spaces, we’ll destroy our reputation even further.

So where don’t ads belong? Would you like to see them in these spaces, or would you insist that they be banned there?

  • Signs in public parks.
  • The home screen of your mobile phone.
  • The display screen on your car’s dashboard.
  • Graffiti on buildings.
  • The display screen on your computer, when it’s not in use.
  • The tools you use for producing content, like word processors and graphics programs.
  • The pages of books.
  • The surface of the moon.
  • Contact lenses (from the wearer’s perspective).
  • School textbooks.
  • Doctor-patient communications.

I welcome your dialogue on this topic, and I know my doctor’s office is interested in seeing what you have to say. What do you think?

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.


  1. Big question, but let’s start here.

    At a high level, if you use a service for free, then you’re going to have to tolerate some degree of advertisement. After all, as many have said, if you the product. Google, Facebook, Slack, and other companies that embrace the freemium model need to pay their employees and incur other costs. They are not non-profits.

    Once you’re a proper customer, though, things ought to be different. I tell my students this every semester.

  2. As someone who works for a large, regional healthcare system, I find the marketing message you saw in your patient portal to be as reprehensible as you did.

    At very least, there were lots of other ways to go about this. A message of “a new care service you may be interested in” would be a better headline, though.

  3. The placement, subject line, and content are all inappropriate. We already pay for health care and health insurance; no provider has an excuse for inserting advertising or marketing in patient correspondence. It’s disrespectful at best.

  4. My take is: things that have been bought outright and paid for should not be subject to ads. That includes parks (paid for with taxes), phones (paid for, and monthly payments for service), car, computer, word processor, graphics program, pages of books, and contact lenses. I consider school textbooks especially egregious; students have no say on which textbooks they use and, if they’re grade-school age, haven’t developed critical facilities to analyze the ads.

    The direct doctor-patient communications should also be out of bounds. Put a notice on the website about “New Services Offered” and specific links that those interested can click, like “Family Counseling” or “Drug Treatment”. Put ads on local radio / TV stations. But don’t use something that looks like a communique from your doctor to push an ad.

    I get extremely irate when a product I’ve bought keeps advertising to me. I didn’t renew my previous (paid-for, not free) anti-virus because they kept having pop-up ads. I will not renew my current antivirus for the same reason. If I’ve paid for the service, leave me the hell alone until it’s time to renew.

    I hope you’re joking about the surface of the moon, but I fear not. Maybe the cost-analysis projections will prevent it happening.