Empathy Through a Screen: Listening and Responding in a Video Visit

The medium changes the conversation—not the need to listen

A remote consultation can still be humane. But camera placement, latency, interruptions and a limited view of someone's surroundings change how attention and emotion are expressed. A 2024 systematic review of 13 articles grouped telemedicine communication challenges into before, during and after the consultation. Another review of conversation-analysis research found that technology affects how people take turns, build relationships and accomplish clinical tasks. Neither demonstrates that one standard video script will reliably improve patient outcomes.

Before the call

Check that video is clinically appropriate for the concern. Arrange qualified interpretation or accessibility support when needed. Help the patient know how to connect and whom to contact if the connection fails. Position the camera at eye level, reduce background noise and use a private room. Ask whether the patient has enough privacy and wants someone else to participate.

During the conversation

Introduce yourself and confirm that the patient can hear and see you. Avoid diagnosing facial expressions from pixelated video. Look toward the camera at moments of empathy, but do not pretend constant camera gaze equals listening. Explain when you need to look away to check notes.

Use brief invitations:

• “What matters most to you about this today?”
• “I noticed a pause. What are you thinking?”
• “I want to be sure I understood what you meant.”

Allow extra time for delays and overlapping speech. Summarise before moving to a new topic. When visual information is inadequate, say so instead of making an unsupported clinical judgment.

End with a reliable plan

Recap what you know, what is uncertain, what happens next and who arranges any test or review. Invite the patient to describe the plan in their own words without making it a quiz. State how to obtain urgent or in-person care if symptoms change or a physical examination is needed.

What the evidence can and cannot say

These are practical communication recommendations based on qualitative and implementation evidence; they have not all been validated in randomized trials showing better health outcomes. Video is one option, not a replacement for an appropriate in-person assessment.

Selected evidence

Ritunga I, Claramita M, Widaty S, Soebono H. Challenges and recommendations in the implementation of audiovisual telemedicine communication: a systematic review. Korean Journal of Medical Education. 2024.

Seuren LM, Ilomäki S, Dalmaijer E, Shaw SE, Stommel WJP. Communication in Telehealth: A State-of-the-Art Literature Review of Conversation-Analytic Research. Research on Language and Social Interaction. 2024.

HHS Telehealth: Helping patients prepare for their telehealth appointment. Updated May 2025.

WHO: Consolidated telemedicine implementation guide. 2022.