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Coproducing an accurate and timely diagnosis requires effective engagement of the patient whether the encounter is in an office or through telehealth. Similar to in-person interactions, the clinician-patient relationship and the level of patient involvement can influence the effectiveness and quality of the telehealth encounter.^13,14 Family members or onsite aides can also contribute to the evaluation by providing context and help with elements of the physical exam. With appropriate attention to their “webside manner,”ⁱ providers say that a telediagnosis visit feels like a house call.¹⁵

The ability to communicate effectively during telehealth interactions is a core competency for clinicians. Studies suggest that clinicians should draw on similar communication skills for telehealth visits to those used when they are face to face with their patients.¹³ These skills include deep and reflective listening, motivational interviewing, and critical nonverbal communication attributes, such as eye contact.

Many clinicians already struggle with fostering presence and connection with patients during clinic visits.¹⁶ Creating presence during telehealth visits may prove even more challenging. Clinicians will be required to adopt additional skills to effectively develop relationships, engender patients’ trust, and avoid depersonalization of the remote encounter. Many healthcare organizations have developed orientation training for their clinicians new to virtual encounters, and publications with tips and advice are widely available to optimize “webside manner.”¹⁵ While some of the skills needed for a successful telehealth visit are similar to those needed for an effective in-person visit, additional skills include how to prepare for the encounter, what to wear, how to adjust the lighting and background, how to summarize the visit, and the need to outline and confirm patient’s understanding of next steps.^16-18

Research suggests that if the patient does not have a previous relationship with the clinician, video visits are preferred and provide a more natural setting to establish clinician presence and effective patient engagement.¹⁵ Clinicians may be more comfortable with telephone visits for their established patients. Despite its importance to diagnostic safety, little attention has been paid to the impact of patient engagement and patient participation in telediagnosis,^17,18 beyond patient satisfaction. Patient engagement strategies to improve telediagnosis, and studies to evaluate them, are now needed.

^i. In April 2020, Joseph Kvedar tweeted: “there is a concept called “webside manner”. it indicates that providers should be as engaged as possible. establish good eye contact, etc. #teledx”

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