​In the age of telemedicine, providers must strive to create intimate and personal connections with patients over a computer, a new skill some are calling a “webside" manner, according to an October 26, 2017, article in Wired. Accomplishing this is not easy, the article said. For one, technology issues such as blurry webcam resolution and spotty internet connections can impact a provider's message. Subtle elements such as the look of the televised backdrop, the lighting level, and even what a provider is wearing can affect the message. Body language can also be more noticeable on a webcam, the article said. When sitting in the same room as a doctor, a patient might not notice him or her slouching or turning away to sip coffee, but these movements can be magnified onscreen. Keeping these little elements in mind can become overwhelming for a physician, the article said. "There are some people who are great in person, and you put them on camera—they're a dead fish," said the associate director of evaluation for the University of Arizona's telemedicine department. Some hospitals are addressing this issue by building their own telemedicine clinics, which allow them to control as much of the physical environment in the video as possible. One such clinic discussed in the article designed its telemedicine room to “look like an office, but with better lighting." But environmental factors can only go so far. Ultimately it falls on the physician, the article said. A 2016 study in JAMA found a wide variation in quality of care and bedside manner among virtual urgent-care clinics. According to Wired, the study's author also noted a reduction in referrals to specialists, which he hypothesized as being because telemedicine doctors often live in a different city from the patient and do not necessarily know local specialists to refer them to. This could be solved by some back-and-forth conversation and an ongoing patient-provider relationship. The Wired article quoted a pulmonologist saying, "Webside manner definitely requires more cooperation, and a different kind of cooperation, than bedside manner."

HRC Recommends: As with the implementation of any new technology, organizations should review the intended goals of using the technology, the process of using the technology (e.g., how it fits into or supplants current workflows), and the potential risks and benefits of using the technology. Telemedicine, when used well, can improve the communication between a practitioner and his or her patients; however, if it is used without care, communication can become muddled or erroneous. As suggested by the Wired article, consideration must be given to maintaining the patient-doctor relationship, despite the virtual nature of the encounter.