How to build trust in a virtual world

Rachid Akiki, MD, MBA
7 min readMar 25, 2021


Trust is a delicate matter. It is usually harder to achieve it in a virtual world than in person. However technology can help us overcome a variety of challenges. This small article is about sharing my experience in building trust with employees, doctors and patients while launching Bookzdoctor which is my first Telehealth startup, based in Boston, USA.

“He who does not trust enough will not be trusted.”

It started in January, 2020, with COVID19. As a medical doctor trained in nuclear medicine research & molecular imaging with a fresh MBA degree, I explored opportunities away from the beaten clinical path, and worked in the pharmaceutical industry. I was employed in the management of several global clinical trials at Biorasi LLC which is a niche contract research organization specialized in rare diseases located in FL. The special thing about this organization is that they decentralized all their clinical trials, and they were able to build a software called Talos to track the complicated milestones & FDA requirements of clinical trials, across a variety of clinical sites, and across borders.

Management & organization was important, but culture and building trust between international offices, clinical sites, vendors and FDA regulators was trivial for success. With that in mind, I started to put together a mind map with small milestones on what would it take to build trust between people in a virtual setting, and how to best implement these strategies, and apply them in any business.

A complex system that works is invariably found to have evolved from a simple system that worked. A complex system designed from scratch never works and cannot be patched up to make it work. You have to start over with a working simple system. — John Gall

With the rise of COVID19, I took a risk, left a secured job, and dived into the entrepreneurial world. Since then, it has been one hell of a ride so far. I have built a team of 40 people all working remotely, a HIPPA compliant platform that connects doctors to patients, and a system that delivers highly focus & personalized attention to clients such as a behavioral and fitness program overseen by medical professionals and healthcare coaches.

Most of us wouldn’t turn to a stranger on the street and tell him/her about our struggles and pains, intimate issues, or our deepest fears about the future. And yet, every single day, patients see new doctors for the first time and share intimate details about their bodies and their worries. Clients/patients trust us with their most intimate day to day life events and they appreciate the value and focused attention that they get to reach their goals. To be able to reach that level of personalization, and to be able to sell high ticket services, trust is at the core of operations.

Trust: competence, logic, empathy, and reliability.
  1. Communication

Physicians are trained to have good bedside manner. They can take a good history relatively fast. They are able to know the struggle, the goal and can build a dynamic differential diagnosis. Same for coaches. Therapy & coaching are more commonplace than ever. But to some, they’re still taboo. I’m a huge believer in both. The most high-leverage jobs involve mostly listening & questioning:

1) Investors
2) Therapists
3) Doctors
4) Exec coaches

Which means, listening & questioning are two of the most high-leverage skills. Nonetheless, the first virtual impression matters a lot. It’s harder to establish credibility if cannot have appropriate chatting conversations, or if you don’t intend to make eye contact and engage because your camera image quality is low or if your background appears informal. Quiet surroundings & looking clean, approachable and professional will create the impression you’re looking for.

Technology itself & social media presence works to amplify a physician’s credibility. If done in the wrong way, it will affect it in a negative way. Paradoxically, the best way to demonstrate competence is not by talking up your own experience; it’s listening empathetically. Focus intently on what patients/clients are telling you about their symptoms or struggles and repeat key phrases to ensure you’re understanding: “It sounds like you’ve been struggling with losing weight for over a month. Is that right? Can you tell me more on how is this affecting your life?”

2. Logic

Patients/Clients want to know, perhaps not entirely realistically, that you remember them, know about them, and are thinking about their problem comprehensively and logically. This is actually easier to do in virtual encounters than in-person ones. At Bookzdoctor we have developed an AI system for automatic reminders, notifications, and personalized workflow through systems like Slack, Airtable, MongoDB, and Google Dialog Flow to make sure everyone feels cared for, and assisted at every instance. We can track records, notes, and important information to know exactly how to design a plan of care. We also do share the screen from time to time to walk them talk through the records and data with them. This has been a huge value.

3. Empathy

The reality is that there is no script for empathy. It’s less about what you say and more about showing up and listening well. Create that connection. That’s the magic. We do a lot of lead generation and the core of how we train our contractors is based on defining the leads, building trusts, and giving them the tools to help leads achieve part of their goal. If these leads feel the value, then our sales team hop in and pitch to them our full serviced programs. The chances of conversions are high.

Conversation starters:

  • “Hey Kevin! Where are you from? (or find something on their profile to compliment them on or start a convo) or cool kids! How many do you have?”
  • “I noticed you’ve been following me and we haven’t yet connected (or thanks for liking my post. Or I saw your comment) Where are you from?”
  • “What do you do for work? Does it keep you busy?”
  • “Great group to join, what brings you here?”
  • “Oh wow does it make it hard to workout? Oh wow is it hard to eat healthy that way? Is hard to be focused?”

Topic Transitions:

  • “Oh wow, does it make it hard to work out?”
  • “Oh wow, is it hard to eat healthy that way?”
  • “Oh wow, how does it make you feel?”
  • “How hard is it to stay focused?”

Always keep in mind that your replies should always have acknowledgment of their answers, and make sure that you have an open ended question there.

Trust Building:

  • “Yes, I totally get it…”
  • “It’s not easy … I feel you…”
  • “That’s unfortunate, it’s very hard sometimes…”
  • “I know how you feel …”
  • “I am sorry you are going through this …”
  • “That sounds really challenging …”
  • “I can’t Imagine what you must be going though…”
  • “This must be hard to talk about, thanks for opening up to me…”

Out of this small conversation you can retrieve so much info such as Info on why they are struggling, info on what they are looking for, info on how they tried to solve it, info on since when they have been stuck, info on where to find them such as email, phone, or home address.

What to say and what not to say.

4. Reliability

Being punctual, confirming appointments, and showing up ahead of them on the calls, or on the zoom video chats is crucial. Being there when the patient/client needs you. Telehealth appears to enable convenient and ready accessibility, and at bookzdoctor we equip physicians’ & Coaches’ and our team with schedules through Calendly that are optimized to meet everyone’s needs. Staying on time for visits is critical in signaling to patients you are there when they need you — that you are reliable.

It’s not easy enough for people to open up and talk about their most intimate experiences and fears online ; adding more challenges to people who cannot really adapt to these changes.

I believe the future is bright, and we are working on a virtual reality application through Oculus Quest 2. It’s an augmented reality where the client and patient are in an ideal environment where all their senses are provoked for an ultimate experience that might be even more real than real life. It may be more efficient in some ways. Technology is helping patients in rural areas get proper medical attention and care. For some patients and some providers, technology is a limiting factor, and if these people don’t learn to adapt, they will be left behind. Today, an in-person visit brings much more value. However we are evolving and building systems exponentially, and that’s why it’s so crucial for physicians, coaches, and therapists to put in the extra effort and ride the Telehealth wave. Join us at bookzdoctor and get in touch if you have any questions.



Rachid Akiki, MD, MBA

Decentralizing healthcare 🚀 Medical Doctor turned Serial Entrepreneur. Boston & Miami-based. Studied physics, medicine, radiology, & business. Always Learning