The rapid expansion of telemedicine fueled by the COVID-19 pandemic has left many doctors scrambling to carve out impromptu office spaces in their homes.

Bringing patients virtually into their personal spaces has been a matter of necessity. Things like background room décor, however, have been low on the list of priorities. As the coronavirus pandemic drags on and temporary setups become more permanent, is this changing?

Ten months into this new way of life, is it still OK to plop a laptop on your kitchen counter for a patient visit? We asked two longtime telehealth neurologists about the visuals — things like background and clothing — of telemedicine.

Dr Jaime M. Hatcher-Martin and Dr. Elaine Jones both work for SOC Telemed, a company that provides virtual care in ERs across the country. Both also work from home. Here’s what they had to say about this brave new world of telemedicine.

‘Make Sure You Look Professional’

NI: Does your company have a dress code?

Dr. Elaine Jones

Jones: SOC Telemed doesn’t have detailed requirements. They just say make sure you look professional, background and clothes. Some of us have dark-blue scrub tops that have the company logo on them.

NI: What should you wear on a video call?

Hatcher-Martin: You certainly still want to look professional. Try not to wear clothing that too closely matches your background or your skin tone as you can blend in over camera. Also, clothing with busy patterns can look distorted on camera.

Jones: Clothing is important because certain things look strange on camera. Stripes can be dizzying, green in front of the green screen will make you disappear. It is OK to wear shorts or comfy clothes on the bottom half – we joke about our yoga pants for work – but be sure you NEVER will be standing up.

Neat and Uncluttered Backgrounds

NI: Does your room’s background matter?

Dr. Jaime M. Hatcher-Martin

Hatcher-Martin: Yes. It should be neat and uncluttered. In my office, patients see a blank wall (taupe with wainscoting) and a door. In my prior office, it was a bookshelf.

Jones: We are professionals and so having household items in the background or family/pets/kids wandering through is not really appropriate. However, beyond that I am not sure it has to be “office-like,” meaning diplomas behind you. We are people and everyone knows this is being done from home at times. So, having some family photos or pictures, tables, chairs behind you could be fine.

Additionally, you can get a green screen fairly inexpensively online and then use the virtual backgrounds to make it look like anything – an office, library, etc.  

NI: What do you think of automatic backgrounds available on platforms like Zoom?

Hatcher-Martin: I think these are OK depending on what they are and how well they work. Some of them can be much too distracting. Other times, they don’t work very well and parts of the person speaking are not visible, so it really should be tested first.

Jones: We were recently given a virtual background to use on Zoom that has the company name and a solid teal background.

Lighting and Shadows

NI: Do you use any additional lighting in your room to enhance visuals or do you just use room light?

Hatcher-Martin: I try to avoid overhead light as it can create unattractive shadows on your face. I have three screens – a laptop and two external monitors, one on either side – as well as a lot of daylight in my office; the window is behind my screens so it illuminates my face. These generally provide enough light but if I am working at night, sometimes I use a reading light with a diffuser over it to provide soft illumination.

Looking in the Eye

NI: Any tips on where to place your camera?

Hatcher-Martin: Do your best to position the camera so that it appears you are looking at the patient when doing the exam. Mine is placed right above where I see the patient on screen to accomplish this. Using more than one monitor can help you multitask more easily, seeing the patient on one and typing or viewing images on other screens. It’s helpful to leave enough space in your self-view to show hand gestures when talking or describing.

Jones: It is disconcerting to be looking at someone’s cheek, or just the top of their head. Try to put the camera in front of you at eye level or a little above, so as you are typing or asking questions you are generally looking in the direction of the patient/family.  Some suggest that if you have the camera below eye level – if you are looking down a bit at the camera – it can translate into looking down at the person. It is kind of like having someone sit in a lower chair than the boss at a desk.

IT Practice Makes Perfect  

NI: Anything else important or that you recommend for doctors new to video telemedicine?

Hatcher-Martin: Make sure you are comfortable with the software you are using before you start the visits. When I first started out, I practiced with family to make sure I felt comfortable with the program I was using, to see what they saw on their end and to help with troubleshooting, etc.

If you have access to someone who can help with IT or who can make sure the patient is able to log on and that audio and video are working ahead of time, that can be helpful too.