The connection dropped about halfway through, probably due to a connection problem for the patient's Internet, but we reconnected after a few minutes. The audio quality was excellent, video adequate.
This is good, clearly better than telephone. It may never completely replace in person contact, the advantages stack up pretty well.
Next I need to work out how to share screens with the patient. I hope this will enable us to simultaneously view random.org while we roll the die for a random drug screen.
I'm accustomed to scribbling notes on my Tablet PC in my lap, but for Skype the computer sits on the desk in front of me under the Web cam, so I can make brief notes with the keyboard during the visit with little or no disruption. This should make ordering prescriptions online or via fax easier, too, not to mention browsing for patient information documents online.
The informal protocol cues are missing: The patient alerting me she's in the waiting room, inviting her into the office, greeting my dog, escorting the patient out of the office at the end. I imagine new rituals will evolve.
It's not for every body or for every visit, but for the right ones the only disadvantage is the patient doesn't get the healing interactions with the pup.