Providers should dress as they would when they see a patient in person, such as a white coat, business casual clothes, or scrubs. Appearance sets the tone for the visit and can help patients overcome skepticism around whether a virtual visit can be equally as good as in-person care.

Room setup and background are also important to ensuring a high-quality experience for patients. The background should be clean and ideally face a wall that has a photograph, diploma, or bookshelf. Avoid areas where people may be walking in the background, as this would convey to the patient that the area is not private. Some clinicians place a meaningful item in the background, such as a picture, sculpture, or book, that can sometimes spark conversation with the patient. If an ideal physical background is not available, many video conferencing platforms offer virtual backgrounds.

Computers should be set up in a well-lit environment, ideally in front of a window. Alternatively, a light can be purchased that attaches to the computer to assure consistent lighting. Providers should ensure their face is framed within the middle of the camera viewing area and at an appropriate distance prior to beginning the visit. Figure 1 shows an example of an ideal room setup.

Example of an ideal telemedicine setup

Wearing headphones is also a way to show the patient that the conversation is confidential. Furthermore, the provider should set up their computer screen with all charts and information needed prior to the visit to minimize toggling between windows during the visit. Table 2 emphasizes best practices for conducting a virtual visit.

Clear communication and expectation setting with patients is key to integrate virtual visits as part of routine practice. In-office flyers and handouts can be utilized to drive awareness of virtual visit offerings. A simple reference guide for patients on how to prepare for and connect to a visit can also be a helpful addition to a virtual practice. Table 3 illustrates an example checklist providers and staff may utilize.

When scheduling or confirming appointments, several key items should be addressed. Will medical translation services be required? Would the patient like a family member or caregiver to join the visit? Patients should be reminded or invited to test their technology prior to the visit, including their browser settings, camera, and microphone. In the event of technical issues, patients should know who to contact. Ideally there is an individual in the office who could easily troubleshoot some of the most common challenges. Finally, a patient should be clear on how (text message, email, etc.) and when they will receive a visit link to join their appointment. For the first virtual visit, it might be beneficial to do a test visit with the patient in conjunction with an appointment confirmation outreach.

On visit day, in the event the clinician is running behind schedule, the patient should be made aware. Patients often may think they are in the wrong place or have clicked the wrong link if a clinician has not joined right away. If the telemedicine technology does not have a virtual waiting room, one option would be to have a staff member connect with the patient via a video visit first, to re-create a check-in process (insurance verification, demographic information changes, changes to medical history and/or medications, etc.), and then conference in the clinician once the intake is complete. Non-clinical care team members are integral to the success of integrating virtual care into practice as they are on the front lines of care, and can impact a patient’s impression on the value, appropriateness, or ease of conducting a virtual visit.

There has been a perception that a clinician-patient relationship cannot be built or maintained with virtual visits. With appropriate training and guidance, clinicians can develop strong relationships with their patients in a way that augments the relationship that exists within the four walls of an office.

A random survey sample of the adult US population showed a preference for telemedicine care delivery by clinicians with whom they have an established relationship. Fifty percent of respondents were willing to see their own primary care provider via telemedicine, whereas only 17% reported willingness to see a provider from an unaffiliated health care organization [8]. This highlights the perceived importance of the clinician-patient relationship in virtual care. A similar study looking at patient perceptions of exceptional interactional skills via telemedicine found that patients often value a clinician that is caring and concerned, using non-verbal gestures to convey that sentiment [9]. This involves making eye contact with the patient by looking directly into the camera and having appropriate facial expressions. It is important to note that a camera and lighting can exaggerate facial expressions, so this should be considered. A useful tip is for the clinician to look at their own facial expressions through the video platform while speaking with the patient and adjust in real time.

Acknowledging limitations of the visit and setting the stage for what to expect is especially important for patients new to virtual care who may have hesitation. Patient comfort and privacy is of utmost importance. Unlike a medical office that is specifically designed to ensure privacy, a patient engaged in a virtual visit may worry about household members listening in on the call (on both the patient and provider end) or be uncomfortable sharing sensitive content over video or image with a provider who is not physically with them. Providers should explain to the patient that the visit is not being recorded, the video will not be shared or posted anywhere, and all aspects of the visit meet HIPAA compliance guidelines.

Providers should determine in advance whether they will actively document during the encounter or wait until afterwards. Such a decision may be made in consultation with the patient — some patients may find typing/clicking noises distracting and request it be saved until after the encounter. The same considerations should be taken when using multiple windows to access the patient’s chart or verify recent guidelines. In many cases, acknowledging and explaining behaviors that may be perceived as rude (typing as the patient speaks or not making eye contact due to screen setup, for example) can set a patient’s mind at ease and ensure patients are aware the provider is placing their care at the forefront.

Without having the familiar environment of a doctor’s office, providers may sometimes need to over communicate the care plan for patients. Patients may require coaching throughout the visit to assist with the physical exam. For example, the provider may wish to explain the physical exam in piecemeal format allowing the patient to follow the directions step by step. In doing this, the provider can ensure a higher quality exam and place the patient — especially one who is experiencing virtual care for the first time — at ease.

Much like an in-person visit, helping a patient understand their condition and symptoms leads to better outcomes and improved quality of care. This includes stating a review of what was done, the findings of the examination, treatment plan, and next steps. Allocating a portion of the visit for the patient to ask questions can be a valuable way to ensure understanding of the agreed-upon treatment plan while also providing an opportunity for the patient to voice any lingering concerns. It can be off putting to patients to “hang up” or “end” the visit, so the shared decision-making, follow-up, treatment plans, and next steps need to be actively communicated, as well as anything the patient can expect to receive at the conclusion of the visit, such as a care plan through a patient portal or notice of a follow-up appointment, for example.

Video visits allow providers the opportunity to peer into a patient’s home or living situation in a way they could not experience in the face-to-face setting. In working with the patient to develop an ideal treatment plan, the provider can consider their situation and nuances within their home that may present challenges. Additionally, video visits allow for an easy connection to caregivers, friends, and family members who may want to participate in the conversation. Most video visit platforms allow for at least 4 participants in a call. This is particularly useful in older patients who may not have loved ones nearby. Additionally, video conferencing can be utilized to bring in other care team members, such as PCPs, case managers, pharmacists, therapists, or other specialists who may be involved in the patient’s care. Table 4 summarizes best practices to develop exceptional webside manner.