Video or Telephone? Choosing a Remote Consultation Together

Which remote format will serve this patient?

The best telemedicine choice depends on the clinical question, the person's communication needs and access to technology—not only on what a clinic has available.

Video can add visual information and sometimes makes it easier to demonstrate a technique or include a supporter. Telephone may be more accessible where bandwidth, digital confidence or privacy is limited. Neither can reproduce every element of an in-person examination.

What comparative studies show

A systematic review of randomized trials comparing telephone with video consultations for people with established conditions found no notable differences in the outcomes studied, but the included trials were few and varied. Critically, they did not address patient safety or new diagnoses adequately. A broader review of 79 comparative publications more often favored video, particularly when visual information or participation mattered; however, its mixed study designs do not mean video is universally superior.

The evidence does not establish a winner for every patient or every condition.

Questions to decide together

• What is the clinical purpose: follow-up of a known problem, new symptoms, medication review, counselling, or an examination?
• Would seeing the problem, movement, equipment or a demonstration matter?
• Can the patient reliably use video, or would it create stress or exclusion?
• Does the patient have enough privacy for the chosen medium?
• Is an interpreter, accessibility aid or caregiver needed, with the patient's consent?
• What is the alternative if the technology fails or the clinician cannot assess safely?

A clinician should explain when remote evaluation is insufficient and arrange timely in-person care. Patients should not be pressured to use video merely because it is the clinic's default.

A shared decision sounds like this

“Video may help me see how the movement looks, but I cannot complete every examination remotely. Would a video visit work for you? If not, we can discuss telephone or an in-person appointment. If we cannot assess this safely at a distance, we'll need another plan.”

Selected evidence

Byambasuren O, Greenwood H, Bakhit M, et al. Comparison of Telephone and Video Telehealth Consultations: Systematic Review. Journal of Medical Internet Research. 2023.

Caffery LJ, Catapan SDC, Taylor ML, et al. Telephone versus video consultations: a systematic review of comparative effectiveness studies and guidance for choosing the most appropriate modality. Journal of Telemedicine and Telecare. Published online 2024.

AHRQ: Telediagnosis—implications for diagnostic quality and safety. 2020.

WHO: Consolidated telemedicine implementation guide. 2022.