I have read this thread with interest and, as usual, the medfet community has spoken a lot of sense prompted by an enquiry by somebody seeking knowledge. A model of how it ought to work.
I have found webcams to be a distraction - fiddling about to get the appropriate shot, fuzzy images and so on have tended to detract from the experience for me so i tend to prefer text based with a large dose of imagination.
Sometimes doing an examination without prior chat with the patient can be fun: after all we don't always have the luxury of chatting with our r/l doctors or even meeting them prior to an consultation!
Online exams are safe: there's no physical contact, no meeting relative strangers. You can use them to explore limits without having to actually go there, perhaps prior to the real thing. You may not know if you like the idea of being restrained for eample. A cyber exam will help you decide if you want to try it for real. I know it's not the same but it takes it a stage further than just your imagination.
And of course either party can stop the interaction at any time: I would hope politely rather than just logging out of MSN!
What kills it for me is a patient who can't / doesn't enter into the situation. Constant monosyllabic replies don't do it for me and it's hard work, even after an oos question as to whether it's OK for them.
So please patients- Join in, give feedback, use your imagination and lie back on the couch and wait for the doctor to come into the room.