Telepsychiatry Lighting Fundamentals: Lights, Camera, Action…

Think about a great scene in your favorite movie.  What made it have so much impact?  Was it the screenplay, the acting, or the scenery?  You may not have thought about it, but chances are that the lighting and color of the set made a big difference.  The way the lights were positioned captured the right tone.

Just like a movie set, the quality of lighting will set the tone during a telepsychiatry encounter.  Light and color are two of the most important factors in establishing a great telemedicine office atmosphere.  Use the right lighting, and you will convey a sense of professionalism which will inspire trust in your patients.  Use the wrong lighting, and you may appear brooding, mysterious and maybe even intimidating- these are not qualities patients want in their doctors!

Even the highest quality videoconferencing cameras cannot compensate for poor lighting or color in the room.  Hollywood studios use every technique at their disposal to assist the camera in capturing the image properly.  Similarly, using techniques to optimize the light and color in your office will improve the performance of your videoconferencing camera.  The goal is for your camera to produce an image that reproduces what you and your patient would see if you were together in the same room despite being located many miles apart.

Why Light Matters in Telemedicine:

Inadequate lighting is not only unpleasant for patients and doctors, but it can also be a significant impediment to making an accurate mental health diagnosis.  A key piece of information for behavioral health providers is the affect, or emotional expression, of the patient.  Without this information, providers are taking a “shot in the dark” when formulating a diagnosis and treatment plan.

It is crucial for the telepsychiatrist to clearly see the patient’s face so that she can make an accurate diagnosis.  It is equally important for the patient to see the doctor’s face in order to gain trust and comfort during the telemedicine appointment.  The position of the lights will have a great impact on how well the telemed doctor and patient see each other.

What are the common lighting mistakes in a telemedicine office setup?

Back Lighting:

When posing for a photo, having the sun blaring behind your back would make for some lousy pictures.  The same is true for videoconferences.  When the light source is at your back, it places your face in a shadow.  Avoid placing your light source directly behind you.  Even if your windows and lamps have shades, they will still allow light to pass through.  Light at your back will result in a patient being unable to see your face- this defeats the purpose of face-to-face telemedicine encounters.

Front Lighting:

If your front lighting is too bright, you might appear to have a glare on your face.  Instead of paying attention to what you have to say, your patient will be focused on your shiny face.  Furthermore, excessive front lighting may bleach out the features of your face.  Your patient will be unable to see your expression and their trust in you will literally fade away.

Direct Lighting:

Light coming from only one direction will act as a spotlight and casts long shadows on you.  One side of your face may appear bright while the other side will be dark.  This will make you appear as if you are emerging from a dark alley.  Doctors need to comfort their patients, not frighten them!

So what is the answer?

The Best Way to Position Light:

The goal is to have gentle and well distributed light.  Light should be coming from multiple sources and locations in the room.  Use a combination of desk lamps, torch lamps, fluorescent overhead lights, and natural light coming from windows.  This will ensure that your entire face appears clearly and is free from shadows and glare.

True Colors:

The patient image needs to truly convey the color of the patient as he appears in real life.  Skin appearance is information that is often critically important for a proper assessment of the patient.  Changes in the skin tone of the patient may be evidence of conditions such as organ failure, cancer, infections or allergies.

Unbalanced colors can interfere with the telemedicine provider’s ability to accurately diagnose medical conditions.  For example, rooms that have yellowish lighting may falsely give the impression of jaundice and worsening liver function.

Therefore, pay attention to the color temperature of the room and make adjustments such that there is an even distribution of colors. Keep reading for more details…

Indoor vs. Outdoor:

Various forms of indoor and outdoor light occupy unique positions on the visible light spectrum and have a variety of affects on the image a camera produces.  The color of outdoor light depends on the time of day as well as weather conditions.

Furthermore, in the Northern Hemisphere, northern light will have a more neutral appearance and southern light will have an orange tinge.  Therefore, telemedicine offices that have northern facing windows enjoy better light for appointments.  The reverse is true in the Southern Hemisphere.

The color of indoor light can also vary significantly, depending on the source.  Incandenscent bulbs may have a yellowish hue.  Fluorescent bulbs, on the other hand, provide a fuller spectrum of light.  Keep in mind that the quality of fluorescent bulbs can vary substantially- the lower quality bulbs will skew colors whereas “full spectrum” fluorescent lamps reproduce the camera images more accurately.

In addition to transmitting a fuller spectrum of light, fluorescent bulbs diffuse light nicely- this helps provide an even light source which is free from shadows.  Thus, fluorescent bulbs are commonly used in office buildings.  Nevertheless, it is often helpful to supplement fluorescent lamps with other light sources in order to achieve the appropriate contrasts without creating shadows.

It is often helpful to equip your telemedicine offices windows with blinds or shades in order to manually control the amount of light entering the room.  This will allow you to find a nice balance between indoor and outdoor light.  It will also help distribute the light evenly to reduce glare and shadows.

Off-the-wall Colors:

The colors in view of telemedicine cameras have a significant impact on how your image appears.  Walls painted with strong and dominant colors such as orange and red will skew your appearance with unnatural hues.

Also, the color of the wall may fool the camera.  Overly white walls may result in the camera letting in less light through the aperture.  As a result, your facial features may be hidden in darkness.  Conversely, very dark walls will have the opposite affect: they will make your face appear bleached and without contours.  The best wall colors are off-white, light grey, or light blue.

Although every wall in your office will contribute to the effect, the primary wall of importance is the one directly behind you.  It may be worth repainting the section of the wall that appears on camera.  If you aren’t in the mood to paint, hang a sheet or photography backdrop on the wall.  

Other Sources of Color and Light:

Be wary of sources of color and light that may skew your appearance or serve as a distraction to your patient.  If your telemedicine office window faces a street, light from cars will pass rythmically over your face and divert your patient’s attention.  Likewise, bright neon and/or flashing lights will make your patient wonder whether you are in a doctor’s office or a cheap hotel!

Many telepsychiatry setups include multiple monitors.  The color of the monitor can artificially color the appearance of your face.  For example, the blue sky wallpaper on your monitor may result in a patient seeing a blue doctor.  Blue faces are best reserved for broadway actors, not physicians!

Be cognizant of these and other lights sources that will detract from the tone of your telepsychiatry appointment.

Let Their Be Light… Good Light!

Before your next telepsychiatry appointment, take time to check the lighting and color. Have someone on the other end tell you what your image looks like, and vice versa.  It will take some time to set up the lighting just right, but it will be well worth the trouble.  With the right lighting, the appointment will feel more natural and your patient will feel more comfortable with you. Once you have the right office light, you can begin shedding light on what ails your patient!