World events have created a boom in all things video conferencing. Kids, teenagers, grandmas, and office workers alike are turning to video services like Zoom or Skype to connect with their friends, family, or colleagues—while staying safe at home. 

With this sudden influx of virtual meetings, check-ins, and happy hours, I’ve had a big realization. Very few of us are actually good at hosting video calls—and we all suffer (to some degree) from poor resolution, sub-par audio quality, or some kind of bad remote communication etiquette. That’s fine in a casual setting, but it might not fly if you’re in the middle of treating a patient—especially one who’s not completely sold on telehealth.

We want rehab therapists to have a smooth transition into the world of telehealth, which is why we decided to compile some common telehealth tech blunders that could really trip you up if you’re new to the virtual care game. (Also, if you haven’t already, be sure to check out WebPT’s telehealth solutions, which will help ensure you avoid many of these blunders in the first place.) 

Note: This article uses telehealth terminology that you may or may not be familiar with—so if you need to brush up on the lingo (e.g., “asynchronous” or “e-visit”), check out this telehealth post from John Wallace, PT, MS, WebPT’s Chief Business Development Officer of RCM. 

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1. Lack of Clear Communication

This applies to: 

  • asynchronous and synchronous e-visits, 
  • asynchronous and synchronous telephone visits, and
  • synchronous telehealth visits. 

Patients love clarity. They love knowing exactly what they need to do to make sure their entire appointment experience—from scheduling to payment—goes off without a hitch. Unfortunately, transitioning to telehealth means you need to revisit your communication process, because you can no longer ask patients to swing by the front desk to pay their copay or schedule their next appointment. You must figure out how to streamline your remote communication process—and fast—because patients don’t need any additional stressors on their plate.  

Establishing a Process

While this isn’t necessarily a quick fix, it is a one-and-done type of deal. It’s absolutely crucial that you sit down and establish a step-by-step communication process for patients who wish to receive telehealth services. Make sure you’re thorough and that you address every step of the patient treatment process. Start by asking yourself questions like: 

  1. How will we inform patients about these new telehealth services?
  2. What’s the easiest way for patients to reach out and request one of these services—and how do we teach them how to put in a request?
  3. How do we collect insurance information from new patients—and who does this?
  4. How do we collect payment from patients—and who does this?
  5. How do we follow up with patients—and who does this?
  6. How quickly should we aim to respond to patients (e.g., within one business day)?

Whether or not you enlist the help of a software to handle some parts of the process, it’s important to create a telehealth playbook so the patient experience is uniform and smooth. 

2. Subpar Audio 

This applies to: 

  • asynchronous and synchronous e-visits, 
  • asynchronous and synchronous telephone visits, and
  • synchronous telehealth visits. 

Whether you’re talking with a patient over the phone, recording and sending messages, or communicating via live video conferencing, good audio is the cornerstone of a positive patient telehealth experience. When you meet with patients in person, you don’t have to worry about this sort of thing, because you hear the same things the patient does—so you know when to move because there’s too much background noise, or when to adjust your speech to communicate with patients who are hard of hearing. But making those adjustments on the fly is tough when you can’t hear what the patient hears—and a small noise on your end might sound like a blaring, crackly mess on the patient’s end.

Improving Your Audio

Luckily, you don’t have to buy a top-of-the-line audio system to give patients a good auditory experience. First, eliminate as many ambient sound factors as possible: turn off your squeaky overhead fan, and mute your phone notifications. Additionally, instead of using your device’s built-in microphone, you may want to consider using an external mic. This could be as simple as putting on a pair of earbuds with an internal mic (like this Wistia video recommends) or investing in a low-budget microphone (like our videographer recommends).

The best way to figure out how your microphone sounds is to test it out. Ask another therapist from your practice—or even a family member—to hop on a quick call with you to listen to your audio. If you’re planning to provide synchronous telehealth services, try running through a few exercises with your test partner.

3. Poor Lighting 

This applies to: 

  • asynchronous and synchronous e-visits and
  • synchronous telehealth visits. 

In addition to clear audio, a clear picture is a major telehealth experience factor. It doesn’t matter if you’re talking with patients live or sending them pre-recorded videos for an e-visit; either way, they need to be able to see you—especially if you’re demonstrating exercises. But, if your lighting isn’t set up the right way, then you could end up looking like a shadowy figure whose movements and facial expressions are tough to discern. 

Lighting Your Video

Fixing up your video lighting is simple. The biggest thing you need to know is that you shouldn’t have a light source directly behind you. This will blow out the camera, making the window or lamp brilliantly bright and your face shadowy and dim. If you rotate around, however, and position the light source directly in front of you, it’ll illuminate your face and body. (Check out the above-cited Wistia resource to see this effect in action.) 

If you’re sending video exercises to a patient as part of an e-visit,  then you might not have to worry about lighting at all. Some vendors (specifically HEP vendors) provide libraries of high-quality exercise videos that you can send your patients—as well as a secure patient portal you can use to communicate with patients about their exercises. To see how WebPT HEP, specifically, can assist with e-visits, check out this page

4. Poor Camera Positioning 

This applies to: 

  • asynchronous and synchronous e-visits and
  • synchronous telehealth visits. 

Once you’ve found some good lighting conditions to record video or conduct your virtual telehealth session, it’s time to find the perfect position for your camera. Again, this is something that we tend to be more forgiving about during our personal calls, but your professional calls should look—well—a little more professional. Patients need to be able to see your whole face when you talk—and potentially your whole body if you’re demonstrating exercises. 

Setting Up Your Camera

While there’s no need to overthink your camera positioning, there are a few things to consider as you set up your video station. Start by running through this checklist:

  • If you’re using a stationary webcam, try to position the camera so it’s at about eye level, and stay one arm’s length away from the camera. 
  • Give yourself enough space to move around and demonstrate exercises. 
  • If you’re planning to move your camera around—to show floor exercises, for example—have some stable surfaces handy (e.g., a little table or a stack of books) so you don’t have to hold the camera or set it on the floor. 
  • Tidy up your backdrop. A messy or busy office space can be distracting!  

5. Slow Internet Connection

The applies to: 

  • synchronous telehealth visits.

My boss had a decent Internet connection. At least, she thought she had a decent connection until she started working from home and had to attend a handful of remote video-enabled meetings each day. She did everything right—her camera setup was flawless and her audio was clear and free of background noise. But, her Internet couldn’t sustain a video stream, so her picture was choppy, her audio cut in and out, and it was impossible to hold a real-time conversation with her. 

The moral of this story is that even if you do everything else right, it won’t matter one bit if your Internet connection can’t handle your telehealth video streaming demands. And if your Internet is compromising the quality of your video, then your patients are due for a frustrating (and off-putting) telehealth experience. 

Optimizing Your Connection

If you’re having relatively mild internet problems, then you may be able to fix ’em with a mild solution. If you’re using WiFi, try using a device that you can hook directly into your router—and get an ethernet cable if you don’t have one.

Just like your computer needs the occasional reboot, your Internet router benefits from them, too—so restarting your router can also help. All you have to do is unplug it for 10 seconds, and then plug it back in. Bada bing, bada boom! 

I also recommend limiting your Internet usage during live telehealth calls to help free up bandwidth for the video stream. On your personal computer or phone, you can lose Internet bandwidth to the extra processes that are running in the background (e.g., all those open Internet tabs or open apps). So, be sure to close those down. If that doesn’t help, you might need to turn your eye toward other Internet users. For example, if another person in the building uses the same connection as you—and he or she is listening to music on Spotify or hosting another telehealth visit—that takes precious bandwidth away from your own telehealth call. 

Ultimately, if your internet package isn’t up to snuff, you might just need to upgrade. In Rick Gawenda’s latest webinar, host Mark Milligan, PT, DPT, recommended investing in an Internet package that gives you at least a 15 Mbps download speed and a 5 Mbps upload speed. 


These are challenging times, and pivoting from an in-person practice to a hybrid or completely remote model is stressful, at best. But, if PTs quickly adapt and provide quality remote care to patients, it could change the industry as we know it—for the better.