A system (210, 520) comprising: a therapy controller (213, 413, 523) including a telemetry circuit configured to communicate with an implantable or wearable medical device and a processor configured to execute instructions relating to programming the implantable or wearable medical device; and a communication circuit operatively coupled to the therapy controller (213, 413, 523) and configured to transfer information between the therapy controller (213, 413, 523) and a remote device; the therapy controller (213, 413, 523) configured to: receive at least one input relating to operation of the implantable or wearable medical device; convert the input into proposed programming instructions; apply device programming rules to verify the safety of the proposed programming instructions; and deliver the programming instructions to the implantable or wearable medical device when the programming instructions comply with the rules, the system further comprising a patient feedback device configured to receive feedback information from a patient, wherein the therapy controller (213, 413, 523) is configured to deliver the feedback information from the patient to the remote device using the communication circuit, wherein said patient feedback device i) comprises a camera and the feedback information comprises at least one image of a facial expression or body position or movement of the patient; and/or ii) comprises a sensor configured to measure one or more physiological responses; and/or iii) is configured to capture one or more of a verbal report, a visual indication, and a keyboard input; and/or iv) includes a display configured to present to the patient at least one image of a person who is remotely providing the at least one input relating to operation of the implantable or wearable medical device. a therapy controller (213, 413, 523) including a telemetry circuit configured to communicate with an implantable or wearable medical device and a processor configured to execute instructions relating to programming the implantable or wearable medical device; and a communication circuit operatively coupled to the therapy controller (213, 413, 523) and configured to transfer information between the therapy controller (213, 413, 523) and a remote device; the therapy controller (213, 413, 523) configured to: receive at least one input relating to operation of the implantable or wearable medical device; convert the input into proposed programming instructions; apply device programming rules to verify the safety of the proposed programming instructions; and deliver the programming instructions to the implantable or wearable medical device when the programming instructions receive at least one input relating to operation of the implantable or wearable medical device; convert the input into proposed programming instructions; apply device programming rules to verify the safety of the proposed programming instructions; and deliver the programming instructions to the implantable or wearable medical device when the programming instructions comply with the rules, the system further comprising a patient feedback device configured to receive feedback information from a patient, wherein the therapy controller (213, 413, 523) is configured to deliver the feedback information from the patient to the remote device using the communication circuit, wherein said patient feedback device i) comprises a camera and the feedback information comprises at least one image of a facial expression or body position or movement of the patient; and/or ii) comprises a sensor configured to measure one or more physiological responses; and/or iii) is configured to capture one or more of a verbal report, a visual indication, and a keyboard input; and/or iv) includes a display configured to present to the patient at least one image of a person who is remotely providing the at least one input relating to operation of the implantable or wearable medical device. i) comprises a camera and the feedback information comprises at least one image of a facial expression or body position or movement of the patient; and/or ii) comprises a sensor configured to measure one or more physiological responses; and/or iii) is configured to capture one or more of a verbal report, a visual indication, and a keyboard input; and/or iv) includes a display configured to present to the patient at least one image of a person who is remotely providing the at least one input relating to operation of the implantable or wearable medical device.