Digital communication media like video‐interaction (cf. Skype) are increasingly being adopted in institutional environments like hospitals for physician‐patient interactions. We may expect that the use of a digital medium affects these interactions in various ways and on various levels. In video‐interaction, eye contact for example is impossible due to the position of the camera, which implies interactional behavior through gaze is impaired. This may influence who speaks when, if and how the participants avoid/ solve misunderstandings, etcetera. This project makes headway in our understanding of the impact of new communication media on the role of language‐in‐use as a rich semiotic system, specifically in institutional interaction. This type of contextualized research reveals which communicative aspects users consider important, how they manage their institutional relationship through them and how they go about solving communication problems.