Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

The Sound of Silence

Autumn leaves


Creating silent moments when talking with patients gives them time to process and the opportunity to share concerns that may not otherwise be spoken.

Silence from others during conversations can sometimes feel unnerving. It may cause feelings of fear that you’re not being lively, interesting, or friendly enough. Many believe silence is something to be filled with questions, advice, and encouragement.


But moments of silence in conversations is often helpful for patients. It gives them time to process information and formulate ideas and questions they would otherwise may have found difficult to verbalize. It also lets them build up the courage to bring up a concern they felt uncomfortable discussing.


For example, I’ve heard patients say, “I’m happy that I’ve lost weight, but I don’t know how it happened.” “I know this sounds silly, but my poo has smelled particularly bad lately.” “I’m afraid I might relapse if I stay in this home any longer.” “Do you have time for some more questions?”


There are at least two agendas in every appointment. The patient is seeking either reassurance or a resolution to symptoms. The clinician is hoping to improve patient outcomes. Because of the power differential in a clinical appointment, some patients may assume you’re too busy for their questions.  To help encourage openness, a pause may allow the patient to share their questions and concerns that are bubbling just beneath the surface.


Medical schools are now teaching the importance of silence within the context of specific types visits, with breaking bad news being the most common. In these lessons, students are taught to express empathy and include silence in conversations, allowing patients to express their needs.


If this space for patients to respond and/or react is clear during a time of crisis, it should then follow that it’s absolutely vital in more regular care. Patients, caregivers, physicians, and even colleagues regularly navigate crises at work. By providing a silent moment for our patients, we’re encouraging them to ask questions and share concerns, giving us the opportunity for collaborative care.


The 30 seconds counting “Mississippis” in our heads may be excruciating. But picking up on the otherwise subtle cues which can otherwise be obscured? Absolutely priceless.





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