While the problem of providing adequate health care to remote populations has been widely recognized, little research has been undertaken to evaluate alternative systems designed to provide such care. An essential part of such a system is the communications link between the doctor and the community he is serving. Studying this two-way subsystem is the context of primary diagnosis and patient management, efficiency and effectiveness of color television, black and white television and hands-free telephone were compared with physical presence consultation. No significant differences in performance were found among the three systems using telecommunications. Physical presence consultation was found superior only for detecting secondary medical problems. Significant rank order correlations were found, however, between the years of experience of the consulting physician and both diagnostic accuracy and appropriate patient management. Also, the attitudes of the patients, doctors and nurses alike ranked physical presence over color television over black and white television over hands-free telephone for medical consultations.