The intentional use of silence in conversation is such a powerful tool. It slows things down. It gives room to breath, and emotion time to stretch. But more importantly, it gives space for patients to process things at their own pace.

There’s data to support the use of silence. Studies have shown that time spent talking, and not talking, matters: in fact, when doctors speak less in a family meeting and patients speak more, families perceive the meeting as more satisfying with less conflict. Actual time spent meeting doesn’t matter.¹

This is why, when I teach my residents and fellows NURSE statements for responding to emotion with empathy, I teach it as “NURSES” to include the use of silence. The intentional use of silence is an emotional response skill just like any other, and it requires timing and practice, as well as recognition of when to jump back in.

I’ve seen the use of silence work beautifully. One classic scenario is to use silence after an “I Wish” statement. For example:

A: I came here for a cure, there has to be more you can offer!

B: I really wish there was… (silence)…

Silence in this scenario lets your patients to fill the empty space with whatever’s on their mind. This lets you advance the conversation and explore what matters most, knowing what we know. If you find that you’ve been talking for the past ten minutes non-stop in a meeting, then that’s probably nine minutes and thirty-seconds too long. Take a break. Push pause. Your patients, and your lungs, will thank you.

I’ve also seen silence not work. When I was a fellow, I tried using silence with one of my patients, and after a minute she turned to me and asked “Why aren’t you saying anything?” I didn’t try it again.

Silence doesn’t work as a communication strategy for everyone, just as naming the emotion might not work for everyone. But when it works, it’s a tremendously effective way to explore emotion with empathy.

And it shows your patients that you’re listening, and care about what they have to say perhaps more than your agenda or checklist or the next thing you have to do. It’s this sense of genuine concern and compassion that helps shine the clearest light on what matters most for our patients.

Source:

1. McDonagh, Jonathan R. MD; Elliott, Tricia B.; Engelberg, Ruth A. PhD; Treece, Patsy D. RN, MN; Shannon, Sarah E. PhD, RN; Rubenfeld, Gordon D. MD, MSc; Patrick, Donald L. PhD, MSPH; Curtis, J. Randall MD, MPH. Family satisfaction with family conferences about end-of-life care in the intensive care unit: Increased proportion of family speech is associated with increased satisfaction*. Critical Care Medicine 32(7):p 1484-1488, July 2004.