Through detailed multimodal EMCA analysis, this paper explores consultations between a geriatric patient in a residential rehabilitation facility, his local caregivers, his relative, and his GP, who is present via telepresence robot. The analysis focuses on a) the patient’s interaction with the telepresence robot and the other participants in the opening sequences, including the establishment of joint attention, as a mutual accomplishment; b) how the role of “the competent Video Consultation (VC)-patient” is negotiated and co-constructed (Goodwin, 2013; Jacoby & Ochs, 1995) over time; and c) how the patient displays increasing VC-competences and develops practices associated with a situational identity as “tech-savvy patient” (Suchman, 2009; Zimmerman, 2008).