When I was a med student, I tried to “fix” how my patient was feeling. I learned that many patients need time to sit with their feelings and that listening empathically can be the best approach.
Some of my most cherished memories from training didn’t involve medical care, they’re when I simply sat with patients during their hardest moments. A middle-aged adult realizing their cancer was non-operable. An elderly person struggling to accept their need for assisted living due to cognitive difficulties. A scared teenager hit by a car waiting alone in the trauma bay for their parents to arrive. There’s no pill to give or perfect line to say in these or similar moments. I can’t change their circumstances or rescue them. I don’t understand how they feel, nor should I say that I do.
“The deeper the pain, the greater the silence.” A friend recently shared that quote from Pastor Rick Warren with me. Presence, often accompanied by silence, can be the most therapeutic intervention in the most challenging situations. This practice is called “holding space,” which is giving support and not judging your patient’s emotions.
I learned to affirm emotions with patients the hard way. It was when I was observed by my classmates during med school on our first day working with standardized patients. I considered myself a “people person,” so I readily volunteered. The patient described their recent knee injury and experience of social isolation from not being able to run. I came to medical school to help people, so naturally, I tried to fix it. My first words were, “Are there any other activities you can do with your friends?”
“Timeout,” my classmates said.
I realized the question was a terrible thing to say. The standardized patient shared that my question made them feel worse, like they were responsible for their sadness. “You may be the first person I could confide in, and your response made me feel like I had to keep those feelings to myself.”
We repeated the scene. The second time, I took a breath and said, “That sounds really hard.” Then I listened closely. The standardized patient continued sharing deeper feelings.
In real life, I don’t get an opportunity to refresh a derailed conversation. I err on saying less over more and offering comfort over solutions. I quickly apologize and rephrase if I feel I got it wrong. Here are a few things I’ve learned for how to give space:
1. Create a safe space.
Find a private room. Say to your patient, “I want to make sure we have dedicated time to talk, but I’m also on call. The only interruptions I’ll allow are urgent calls and then we’ll continue our conversation afterwards.”
2. Sit down at the same level as your patient to minimize the power differential.
3. Ask for permission to talk about challenging experiences.
Then start with an open-ended question like, “How are you feeling about this?”
Holding space for others is about keeping the focus on the patient and their experience. The desire to fix other people’s problems is an effort to treat our own anxiety rather than help another.
This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.