Non-doctor perspective here. This is really interesting. I haven't yet experienced a telehealth visit, but during other video conversations and meetings, one is aware of the disconnect between looking at the camera and looking at the other person's face. If I see someone looking at the camera, I know they're not looking at my face. I would actually be a bit uneasy if a doctor was looking at the camera during a telehealth visit because I'd want them looking at me instead.

I had a foreign GP some years ago at an office in a large medical system. I really liked her at first, partly because she would come into the exam room, get set up, and then just sit and look at me intently for a bit without saying anything (before the poking and prodding began). I felt quite observed. I had her full attention. Over the years, as she became captured by the system, she spent almost all of the visit time typing away on the computer. She would then do a hurried exam, never making eye contact and then swoop out to her next 8 minute appointment.

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I do a lot of telehealth cardiology visits since moving part time to San Diego.

I've noticed that when I'm using my 27 inch IMAC for such visits if I don't put the "patient" in the middle of the screen, right below the camera, it does look like I'm not looking at them so I often make that adjustment.

I tend to "read the room" in terms of how much time I spend "looking" at the patient versus time spent pulling up an imaging report or recording what they are saying in a note, etc.

The patient that is clearly not looking at the screen most of the time gets little of me looking back.

With a new patient I want to spend a fair amount of time interacting with them visually.

In general, with telehealth I have more time to spend per visit and I spend more time talking about things that aren't directly related to patient care and during those times I am looking directly at the patient and evaluating response, etc.

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I mostly look at the parade of pop ups reminding me of the many measurements I am failing at

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