This paper describes communication in the opening phases of real-time, video-mediated telemedicine consultations, using the method of conversation analysis, in three NHS settings in the UK. The literature on interaction analysis in face-to-face medical consultations indicates that physicians' capacity to determine topics in consultations is established in the opening phases of the encounter. This is because patients concede the communicative floor to physicians who claim it for themselves by using well-established patterns of interaction. Drawing on 10 teleconsultations, the analysis shows that, for health care professionals and patients, video-mediated telemedicine is unfamiliar terrain, where communication requires constant negotiation of skills and roles, this complexity being added to by the fact that more than one professional participates in the encounter. Analysis of the opening phases of teleconsultations shows them to involve 'floor negotiation' between professionals and between professionals and patients in which they experience discrepancies between suggested 'frames', a term coined by Goffman [Goffman, E. (1974). Frame analysis. New York: Harper and Row.] to indicate interpretive schemas that allow people to understand the meaning of events in interactions in which they participate. Frame attunement is achieved during floor negotiation through various interruptions, interjections and attachments that professionals produce to defend their agenda. The novelty of the setting also made participants negotiate the physical space in which the encounter took place. We make tentative suggestions for the training of participants, based on the limited evidence of this study, which requires extending by further studies based on direct observation.