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The Importance of Silence in Communication

May 18, 2022

A lot of us are scared of silence. Many of us interpret silence in a conversation as “awkward,” or somehow relaying a message that the conversation is not going well, or that the relationship is not strong enough to keep the conversation going.

Clinicians sometimes will also impart additional significance to silence in a conversation with patients – “I didn’t know what to say or respond” – and this makes us feel as if we’re inadequate.

I was therefore interested to see a Pediatrics Perspectives article by Dr. Erica Kaye at St. Jude Children’s Research Hospital and her colleagues at Emory University, Duke University, and Boston Children’s Hospital, entitled, “The Art of Saying Nothing” (10.1542/peds.2022-056862). It is being early released by Pediatrics this week.

The authors cite research that finds doctors interrupt patients frequently – every 11 seconds, on average! I suspect that this is because we are trying to be efficient. After all, we have to get a thorough history and physical on the patient, make a clinical decision, and communicate the management plan to the patient and family – all in 20 minutes – if we’re lucky! Some appointment templates call for 10–15-minute visits.

In this Pediatrics Perspectives, the authors discuss the importance of silence and how to incorporate silence into your discussions with patients and families. They discuss the concept of “invitational silences,” which might be preceded by a sentence such as “tell me more” or “I can’t imagine how difficult this is.”

I encourage you to read this Pediatrics Perspectives to learn strategies and guiding tenets for using silence in your conversations. Even though the authors have the perspective of working with families who are confronting difficult illnesses, such as cancer, the insights in this article can be used by all of us in the conversations that we have with families. We may have to practice using silence before we get better at it, but it is an important skill for us to use and to teach our trainees.

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