Reading the room

By Nettie Reynolds, MDiv, interfaith chaplain 
  

What we notice in the first moments of entering a patient’s room can contribute to whether they feel rushed, understood, seen, or unseen. “Reading the room” means quickly gauging the mood and unspoken dynamics of a group so you can adjust what you say and how you say it. Importantly, it also includes noticing who is absent. Noting absences can give context for how we communicate and care, especially in high-stakes moments. Absence is information. It tells us something about a patient’s experience that doesn’t appear in vital signs or lab results. 

Presence and absence as clinical information

When I worked as a hospital chaplain, I cared for a woman in her 80s who was a widow without children. Her room was always quiet. There were no photographs, no cards, no flowers. The listed emergency contact was a neighbor, a young mother who lived nearby and checked in when she could, but was juggling caring for her children. So, there was no one sitting with this patient and no one asking questions on her behalf.  

Nothing in her chart flagged distress. But at the bedside, her anxiety was visible. She repeated questions, worried about being forgotten, and searched for reassurance. What she needed most was the sense that someone saw her and would remember her. 

The different stories of busy and quiet rooms

Some patient rooms are busy. Family members rotate in and out. Conversations overlap. Decisions are discussed collectively. These patients may still be very ill, but they’re rarely alone.  

Other rooms remain consistently quiet. No visitors. No personal items. No visible signs that someone else is keeping track of what happens there. These rooms often belong to patients with fewer relationships and/or lives shaped by isolation long before illness brought them to the hospital. Quiet rooms can carry a particular vulnerability. The patients in them often have less advocacy and fewer opportunities to feel seen beyond their diagnosis. 

A team skill

Reading the room works best when care team members share what they notice about shared patients with one another. A nurse might notice that a patient never has visitors. A social worker might learn that the emergency contact is a neighbor or a friend. A chaplain might sense anxiety that surfaces only when the room is quiet. None of these observations are strictly medical, but all of them matter. When these details are named out loud, even briefly, they can help another team member see the whole patient. Sharing observations can reshape care. 

Considerations for the LGBTQIA+ population

This kind of absence is especially important to notice in older LGBTQIA+ populations. These patients are more likely to be single, live alone, and less likely to have children. They may arrive at the hospital alone, and/or with support systems that are not immediately visible or formally documented. Reading the room carefully may reveal a patient who hesitates when asked about family, who avoids naming who matters most to them, or who seems relieved when someone finally asks, “Who do you consider your main support person? “Absence sometimes reflects a lifetime of adapting to systems that did not make space. 

Connecting with patients who are alone

Back to the story. One day, I noticed a mystery novel on her bedside table, a book by the popular mystery writer Louise Penny. The title was “A Rule Against Murder,” part of the series in which Inspector Gamache leads investigations. The story centers on a long-time investigator who is happily married, lives in an idyllic village in rural Vermont, and is sustained by a strong community. It’s a world where people belong to one another. I asked her what she liked about the series, and she talked about those very things and about people who look out for one another.  

Subsequently, when I saw her, I asked what Inspector Gamache was up to now. Those conversations changed the emotional tone of the room. Her anxiety seemed to be lessening. She smiled more easily. She felt known, not as a diagnosis, but as a person with an inner life.  

Three questions to help patients feel seen: 

Sometimes reading the room starts with asking better questions. These simple prompts invite connection without forcing disclosure: 

1. Who do you consider part of your support team right now?

This allows patients to name family, friends, partners, or chosen family in their own words. 

2. Is there someone who usually helps you keep track of information or decisions?

This helps clinicians understand advocacy gaps without assuming incapacity. 

3. What helps you feel less stressed and more relaxed? 

Some patients talk about music. Others mention reading, puzzles, conversation, routine, prayer, or humor. Their answers often point directly to small, realistic interventions that can reduce distress. 

Hospitals are full of resources. Volunteers who can sit and play cards. Programs that deliver books or puzzles. Music, conversation, or simply someone willing to listen for a few minutes. When clinicians know what helps a patient feel most like themselves, care becomes more personal without becoming more complicated. 

And when we ask patients what helps them feel most like themselves under stress, it quietly invites us to ask the same of ourselves. This can help us identify and practice what restores us after difficult days. For me, music was always how I reset. After long shifts, I got into my car and turned on the Grateful Dead or Bob Dylan. The music created a boundary between work and home. It helped me leave the day behind. 

In conclusion

When clinicians read the room and share what they notice with their team, patients are less likely to feel invisible or forgotten. Care becomes more coordinated and more humanized. In a healthcare system increasingly shaped by speed and specialization, the ability to notice presence and absence is an essential form of clinical competence. Every room holds a story. Sometimes the first step is simply learning how to look, and then listening closely to what we see. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.