Why being excellent in the exam room does not transfer online
Updated 2026-08-23 · Atiba de Souza
The skills that make a physician trusted in person are the same skills that make them invisible on a screen. Why that happens, and what has to change without anyone pretending to be someone else.
There is a specific and repeated pattern: the physician other physicians refer to, whose patients are devoted, whose judgement is genuinely better than their peers' — and whose practice cannot fill a schedule from strangers.
It is not bad luck and it is not a failure of effort. The skills are genuinely different, and several of the habits that make someone excellent in the room actively work against them outside it.
Why does in-person authority not carry to a screen?
Because in person you have information the screen does not give you, and you are extremely good at using it.
In the room you can see the patient's face, hear the hesitation, notice which explanation landed and which did not, and adjust in real time. You are running a continuous feedback loop, and your expertise partly *is* that loop. Strip it out and you are writing to someone whose reaction you will never see, whose specific worry you have to guess in advance, and who will leave silently if you guess wrong.
That is a different skill. Not a harder one, not a lesser one — a different one. Expecting it to be automatic because you are good in the room is like expecting a great teacher to be a great textbook author. Related, not the same.
What specific habits work against you?
Four, and each of them is a virtue in the room.
- Precision and hedging. Clinically, "it depends" and "in some cases" are correct and responsible. On a page read by a worried stranger, a paragraph of qualifications reads as evasion, and they leave. The skill is being accurate without being unreadable — which is possible, but it has to be done deliberately.
- Assuming the baseline. Years of talking to colleagues builds a default level of assumed knowledge. Patients do not have it, and material pitched at a colleague's level quietly excludes almost everyone it needs to reach.
- Leading with what you do, not what they have. Clinically you think in procedures and mechanisms. The patient thinks in symptoms, fears and consequences. Material organised the first way is invisible to people searching the second way.
- Reluctance to claim anything. Appropriate professional restraint about outcomes turns into pages that never say what they are for. There is a wide space between overclaiming and saying nothing, and most physician material sits at the silent end of it.
Is the answer to become a different person online?
No, and attempts to do that fail visibly.
The advice physicians usually get is to be more energetic, more personal, more present on camera — essentially, to become a content creator. For most this is both unpleasant and ineffective. It produces material that reads as performed, which erodes exactly the thing being built, and it stops the moment the enthusiasm does.
The actual requirement is narrower and duller: say the things you already say, to the person you already help, in the words they would use, somewhere permanent. No persona is required. Most physicians already do this well several times a day, verbally, in consultations. The gap is that none of it is written down anywhere a stranger can find.
What is the one change that moves the most?
Start from the patient's situation instead of your service.
Take the five things you explain most often in a first consultation. Not your procedures — the explanations. The thing you say when someone asks whether this is normal, whether they have waited too long, what happens if they do nothing, why the last thing they tried did not work. Those are the questions people actually type and actually ask an assistant, and they are almost never what a practice publishes.
A page titled with the patient's question, answered the way you would answer it out loud, is worth more than a page describing a service — and it is easier to write, because you have already given the answer a hundred times.
Why does this matter more now than it did five years ago?
Because the intermediary has changed, and the new one reads rather than looks.
A patient used to browse several sites and form an impression partly from design, photography and general polish. Increasingly, a machine reads the available material and produces a summary that the patient reads instead. That machine cannot be impressed by a photograph. It can only work with what has been written down and can be corroborated elsewhere.
Which means the gap between "excellent physician" and "physician a stranger can choose" is now almost entirely a gap in written substance. This is genuinely good news for the careful and bad news for the polished-but-empty. AI for a medical practice, explained for a clinician covers the mechanics.
What should you do first?
Record yourself answering one patient question, properly, the way you would in the room — then have it written down and published.
Not a script, not a performance. One real answer, transcribed and tidied. Physicians who do this once usually notice two things: it was easier than writing, and the result sounds more like them than anything an agency has produced for them. That is the whole method, repeated.
For what the wider work consists of, see what authority-building for physicians actually is, or start from how a physician builds authority outside the exam room.