Telemedicine Camera Tips: From the Actor, To the Medical Student

  • /Reviewed by: Amy Rontal, MD
  • Hello Friends,

    It’s Doug, your standardized patient from the other side of your computer screen.

    So, here’s a challenge you may be facing:

    You’ve been practicing your history-taking.

    You’re starting with open-ended questions and then moving into more specific questions based on what you’ve learned.

    You’re asking one question at a time and offering resources in a non-judgmental manner.

    Then you’re in your feedback session, and I’m pointing out your lack of gravitas and how I’m not sure I would come to you again for my medical needs.

    What’s going on?

    Odds are, it’s time to up your visual presentation game so you look as professional as you are.

    As I mentioned in my last article, “The Life of a Standardized Patient During COVID-19,” like it or not, we are all movie producers now.

    How you present yourself over your Internet platform tells a visual story.

    It’s time to take the reins to make sure it’s the story you want to tell.

    But before we do, let me just acknowledge you.

    You are a medical student during a pandemic.

    Memorizing all the systems of the body and being able to take a history diplomatically while narrowing it all down to a diagnosis is stressful under any circumstances.

    Now you have to add in “playing pretend” over the Internet, buying into mannequins as people, covered in PPE while on-site with masks that fog up.

    And all the while, you’re scared for your own health and that of your loved ones.

    You are doing the impossible in service to your craft and your work is greatly appreciated. Thank you.

    Now let’s give you the gravitas you deserve for being a superhero.

    For you Star Wars geeks, the following are Jedi mind tricks to make sure my focus goes where you want it to go.

    They include the following:

    • Framing
    • Lighting
    • Background
    • The Eyeline Game

    Common Telemedicine Camera Framing Issues and Solutions:

    Problem: Most students with whom I work keep their laptop on their desk. They tilt the screen back and then look at the screen when interacting with me as a standardized patient.

    This puts the camera of the laptop at about chest level with student leaning over the camera.

    The effect this has on me is that the student is looming over me and I feel intimidated.

    As your patient, I don’t feel as comfortable sharing my story … and I’m fixated on your nostrils.



    1. Raise the laptop up on boxes and books so that the camera is a little higher than your head. This gives you just a bit of space over your head and centers you in the frame.

    2. Find the center with just a little bit of space between your head and the top of the screen. If you’re too high in the frame, the story I see is that you’re a bully. Too low in the frame, the story is, “My mommy said I could diagnose you today.”

    3. After you’ve raised the laptop so the camera is a little higher, lean the screen a bit forward. This will keep your eyes closest to the camera and give the proper proportions, so you don’t look like you have a tiny head with a big chin or chest.

    Your ceiling is gorgeous. I don’t want to look at it. Make sure your camera angle is straight-on.

    4. To prevent yourself from crowding the screen, push yourself away from the laptop enough so that you can reach it and type with your arms extended.

    How to Properly Light Your Telemedicine Session:

    As your patient, I need to be able to read your facial expressions in order to trust you. This only works if I can see it.

    Daytime Lighting:

    If you have a big window, excellent. When it’s light out, you want to be facing the window with your laptop in-between. Gorgeous natural light on your face.

    For extra credit, use a curtain treatment that lets the light through but breaks it up bit. This will prevent glare.


    Nighttime (or you live in a windowless space):

    Ring lights are a great idea, or the small lights that clip onto the side of your laptop. However, a lamp with a shade will work as well.

    You’ll want the light to shine towards the top of your face to prevent odd shadows.

    LED and daylight balance bulbs will prevent your being diagnosed with jaundice.

    Telemedicine Background Tips:

    Have as little clutter as possible in the background and angle your camera to only pick up items you want me to see (simple picture, nondescript books on a shelf, simple plants).

    During these times, we have very little control over the environment from which we’re conducting our virtual meetings. You might be in your parents’ home or your bedroom, neither of which is conducive to setting a professional tone. I acknowledge this, *and* my eye is going to be drawn to the things around you.

    I was once in a session and all I was able to see was the bucket of KFC on top of the fridge.  You may be stuck doing our session in a kitchen, but you can definitely remove the bucket of fried goodness from the frame.

    The Importance of Eyeline During Telehealth Appointments:

    Okay, here’s the kicker.

    If you are looking at my body language it will read that I’m not being heard.

    It’s totally counter-intuitive, but there’s a odd balance with the camera.  If you look at me, your patient, on the screen, it reads on my end that you’re absorbed in your computer and aren’t paying attention.

    If you look into the camera, then it looks like you’re relating right to me and actively listening, but in reality you can’t read my crucial body language.

    What to do?

    Telemedicine Eyeline Solutions:

    1. One way is to direct all of your session to the camera and every now and then dip down with your eyes to make sure I’m not bleeding or on fire. Then I, as the patient, feel “heard.”

    2. The other way is to “contract” with me that even though it will seem like you’re not looking at me, you really are looking at me on the screen in order to serve me better.  The same way you would say in person, “I’m just going to write this down to make sure I get all the information” so I wouldn’t feel uncomfortable in a silence while you write.


    By incorporating effective framing, lighting, background, and eyeline techniques, you can start reading on-camera like the professional you are. You’re working hard through impossible circumstances and deserve to practice what you’re learning without being undermined by a bucket of chicken.

    Have a well-lived day,