Telehealth was not on most NP school curricula five years ago. Now it's an enormous part of how FNPs practice. And the skills that work in a clinic do not all translate to a screen.
If you're new to telehealth, or about to start, this post will save you some of the awkward moments.
Telehealth done well is real medicine. Telehealth done poorly is a missed opportunity for connection. The difference is intentionality.
What Telehealth Is Good For
- Follow-ups for chronic conditions (well-controlled hypertension, diabetes, depression)
- Medication management and refills
- Mental health visits
- Lab review and education
- Triage for whether an in-person visit is needed
- Patients with mobility barriers, transportation issues, or rural access
- Brief acute visits where physical exam adds little (UTI symptoms, conjunctivitis, contact dermatitis)
What Telehealth Is Bad For
- Anything requiring a hands-on exam (acute abdomen, joint exam, ear exam, throat exam, full skin check)
- New patient visits where you've never met the patient
- Significant mental status changes or psychiatric crisis
- Pediatric visits for young children who can't engage virtually
- Complex multi-system workups
- Sensitive conversations like cancer diagnoses (if at all possible, in person)
The Tech Setup
- Quiet space, neutral background, good lighting in front of you (not behind).
- Eye-level camera, not below.
- Good headphones with a mic so the patient hears clearly.
- Reliable internet.
- Know the patient's tech — are they on a phone? A computer? Will video work?
The First Minute
This sets the tone. New providers often skip the warm-up and dive into the chief complaint, and the patient ends the visit feeling like they had a transactional encounter.
What works: "Hi Mrs. Johnson, can you see and hear me okay? Great. Before we get into things — how have you been since we last talked?"
30 seconds of warmth. Make it look like a normal visit, not a tech support call.
The Visual Exam You Can Actually Do
Even without your hands, you can observe:
- General appearance, mental status, mood
- Skin rash or wound (have them aim the camera)
- Range of motion of joints
- Gait if they walk in front of the camera
- Eye redness, swelling, drainage
- Pediatric breathing pattern, retractions, work of breathing
- Skin color, jaundice, pallor
You'd be surprised how much you can gather with thoughtful direction.
What to Ask the Patient to Do
- "Can you stand up and walk a few steps for me?"
- "Can you tilt your head and show me your ear?"
- "Can you take a deep breath in and let it out?"
- "Can you press on your belly where it hurts and tell me what happens?"
- "Can you take your own temperature and BP while we talk?"
Patient-performed assessments are limited but real.
When to Convert to In-Person
Say it clearly: "Based on what you're describing, I think we need to see you in person. Let's get you in today or tomorrow."
Don't let telehealth become a barrier to good care. If you need eyes and hands, you need eyes and hands.
Truth: Telehealth is a tool. Tools don't replace judgment. If the visit isn't telling you what you need, escalate.
Documentation Differences
- Document that the visit was telehealth (modality — phone, video).
- Note the patient's location (state matters for licensure).
- Document consent for telehealth.
- Note any limitations to your assessment.
- Use appropriate modifiers for billing (-95, place of service 02 or 10).
The Awkward Moments
You will have these. The patient who freezes on screen for 30 seconds while you keep talking. The patient whose toddler walks in halfway through. The patient who is clearly driving (don't continue — reschedule). The connection that drops three times.
Laugh when appropriate. Pause when needed. Reschedule when you must. Don't let the tech failures become your failures.
Pediatric Telehealth
Easier than expected for older kids who can engage with the screen. Harder for young children. Have a parent describe and demonstrate. Don't try to do a full ear or throat exam virtually for an unwell toddler — see them in person.
Mental Health Telehealth
Some of the most effective use of the modality. Patients often open up more on screen than in office. Pay particular attention to your background and your face — both will be scrutinized. Make sustained eye contact (look at the camera, not the screen, during important moments).
Building Connection Through a Screen
- Use the patient's name often.
- Pause more than you would in person.
- Acknowledge what you see in their face.
- Don't multitask. The patient sees your eyes drift to the chart.
- Smile genuinely when warranted.
- End the visit with eye contact and a summary, not a quick goodbye.
The Long View
Telehealth is not going away. The FNPs who learn to use it well will be more productive, more accessible, and more useful to more patients. The ones who fight it or resent it will struggle.
Lean in. Build the skills. Treat it as real medicine. The patients will tell the difference.