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Patient Advocacy: the 4-paragraph letter

For people impacted by chronic illness, getting involved in patient advocacy can be empowering. More than that, it can be a way to effect change in a system that needs it. Engaging with law makers may feel out of reach or intimidating, but it doesn’t have to be. Here is a format for letter writing that includes all the elements you need for clear communication – the 4-paragraph letter.

The 4-Paragraph Letter

Shouting, “Taking the car”, as you run out the door is a form of communication. I would argue that in most situations it’s not a very kind or respectful one. Saying “Mom, I need to borrow the car to pick up Steve from soccer”, feels better. Both are simple, devoid of noise, but the latter identifies the speaker, respects the audience and has a clear call to action in a context. It’s that second kind of communication that is the foundation of the 4-paragraph letter.

Applying this to other types of writing, and speaking

The 4-paragraph letter was conceptualized as a way to communicate effectively with legislators. It’s short, to the point, clear, impactful, and relies on rhetoric*. However, the principles on which it is built are applicable to all sorts of writing, as well as speaking. Even Aristotle would agree.

*my simple definition of RHETORIC: the art of understanding and connecting with your audience and communicating with them effectively in the practice of writing or speaking.

Deconstructing the 4-Paragraph letter

This letter can easily be customized to any kind of legislator. It is structured to fit on one side of a piece of paper, so manage words carefully and remove anything that does not support your argument.

Addressing the letter:

Members of the U. S. House of Representatives:
The Honorable (full name)
United States House of Representatives
Washington, D. C. 20515

United States Senate
The Honorable (full name)
United States Senate
Washington, D. C. 20515

The 4-Paragraphs:

  • PARAGRAPH 1: Introduce yourself, mention any organization or society you represent. Introduce your Ask.
  • PARAGRAPH 2: Building your case: Make your emotional argument – this is where you make a personal bond with your reader
  • PARAGRAPH 3: Building your case: Your rational argument – check your passion and talk about impact, some statistics, and (if you have room) imagine a world where the solution has been used.
  • PARAGRAPH 4: your Ask/Call-to-action. If your argument has been good, your Call-t0-Action should seem like the only logical solution to the challenge.

An example, deconstructed

(the following is a work of fiction)

This has been about HOW you can practice the 4-paragraph-letter, next time we’ll figure out our WHY.


This Summer Jim has been named Chief Patient Officer at Patients Rising, Jim works very closely with the people to help them tell their stories, and offer solutions. Jim is a Columbia University trained writing consultant and has worked closely with writers of all levels of skill to help them find and refine their voices. He is a writer, editor, author and certified medical assistant with over 20 years of experience in healthcare. Jim has spent over two decades in clinical care and research at some of New York’s biggest health institutions doing hands-on patient care, education and advocacy for rare disease patients. He has worked with several non-profit patient support organizations doing outreach, advocacy and creating educational content. Twitter / Linkedin

Jim Sliney Jr.

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