My fourth (I'm not exactly high volume.) Skype patient contact today, first time from home, spur of the moment to accommodate a schedule change.
For the first time I tried the Share Screen feature, allowing the patient to watch as I rolled the die at random.org for a random drug screen. If you use this feature be sure you don't show the patient your calendar or other window that might display names of other patients.
Before you use Skype away from the office look behind you. Make sure the patient won't see anything you don't want them to see in the camera field.