Telemedicine is not that much different from streaming, and streaming is not the same as downloading a single file. You're not getting a whole file when you stream. You're getting packets of smaller video/audio segments that require regular handshaking to ensure each packet is complete and received in the correct order. Each handshake requires several pings back and forth which may be delayed by different times. Whether the handshake was received by the server in time for the next packet and/or how not receiving it at all is interpreted by the server determines if the stream is halted in a 'buffered' state or not. Making matters worse, telemedicine and other forms of video conversations (e.g., Skype, Facetime) are more complex than this because they're trying to synchronize in both directions, not just one.
... View more