Four core communication skills are “Ask-tell-ask”, recognize and respond to emotion, ask permission to move forward, and “Tell me more…” “Ask-tell-ask” is asking what the patient or surrogate knows about the medical situation, telling them the headline (information and meaning), and asking what they are taking away from your conversation. Recognizing and responding to emotion, both verbal and nonverbal, can allow patients to discuss additional medical information, builds connection between clinician and patient, and can clarify what is important to the patient. Responding to emotion may be nonverbal or verbal (e.g., NURSE statements), and may include simple or complex reflections or “wish statements”. Asking permission to move the conversation forward signposts that there is a transition, allows patients control, and helps you judge if they are ready. Finally, “Tell me more…” helps clarify informational needs or allow a deeper view into a patient’s reasoning or emotional space, giving the clinician guidance on where to direct the conversation. In telemedicine, communication skills need to be adapted as some of the in-person nonverbal skills are less effective or impossible.