In a telemedical consultation, medical information is sought at a distance. Two techniques may be used: asynchronous ('store and forward') and synchronous ('realtime'). Asynchronous consultations have the advantage that the two parties do not have to be available simultaneously; email, for example, has been used successfully for teledermatology. Synchronous consultations depend on communication media such as the telephone, radio or videoconferencing. Successful videoconferencing will involve consideration of four factors: the environment, session initiation, dialogue and session closure. The environment is very important for good-quality consultations and involves planning, equipment and training. Recognizing the advantages and limitations of the available media combined with appropriate planning and training will maximize the utilization of teleconsultations.