Silence is Golden
I’ve been reflecting on how true this phrase is.
Silence is
…a rich vein to be mined for precious thoughts. The ones we hold closest and might be afraid to share.
…the space we create to welcome the riches that follow.
This is why in literature it’s known as a pregnant pause.
So many times I’ve noticed that being quiet has led to breakthroughs, allowed people time to feel their feelings, to come to their own conclusions, to reach decisions they can own.
Gentle prompts, active listening and open questions focussing on their ideas, concerns and expectations can help steer the conversation to new revelations. 3-5 seconds is usually enough for an effective pause.
“Attention is the rarest and purest form of generosity”
I have confession to make.
I (used to) interrupt a lot.
I imagine your response is
“But sometimes interruptions are necessary”. True, sometimes.
But most of the time we use interruptions to save time, they can sadly have the opposite effect.
Have you noticed what happens after an interruption?
Take a minute to notice this next time you observe a conversation.
The interrupted person stops mid-sentence, mid thought, they’ll answer you, then pause again.
“Now… where was I?”
And there’s a real risk that information that really matters is lost. (1)
On average doctors interrupt as early as 18 seconds into a consultation. If patients are given the chance to say what they need to they are usually finished by 2-3mins. (2)
My days of interrupting are reduced but not gone. As I say, sometimes, due to urgency of the situation or due to a striking piece of information, interruption is needed.
But now I’m acutely aware of the impact, and I aim to get the person quickly back on their track.
“Sorry I interrupted, you go ahead”
- And add a bit more silence to allow thoughts to reemerge.
See for yourself
Watch the conversations around you, and reflect on what an interruption does to the conversation.
What if I need to interrupt?
Sometimes for a variety of reasons you might feel the need to step in, but how do you do this in a way that maintains the rapport you’ve worked so hard to build?
If an interruption feels dismissive your conversation partner may feeling that their concerns are being overlooked, and you might find yourself back to square one, needing to work harder for longer to get the information you need.
So, before you go there
Consider whether it is really needed - if you are getting valuable information without talking it might be best to let them keep going
Consider why your patient appears to have a lot to say, are there other emotions you are noticing from the patient - frustration, fear, grief or even positive ones such as relief. Responding to these emotions can help bring the conversation back on track.
For example naming the emotion
“It sounds like you’ve been really frustrated with the lack of information, I’d like to ask some specific questions to get a better idea of what’s happening and then come back to your questions”
Or an empathy statement (empathic interrupting )
“What a tough year you’ve had!
“I’d like to talk about what we can work on now to get you better and back home…”
Both the above statements included a signpost to guide the conversation.
Signposting some more closed questions can also help with quickly gathering background information
“To check over your general health and pick up any issues I’m going to run through a few quick questions… (then ask some closed questions)
If its something important to clarify in the moment, you can signpost his too
“Sorry, can I just stop you there and check (the thing mentioned) because this seems very important”
And if you sense that your interruption has caught your patient off balance, try to create space again
“Thank you for sharing that, please, tell me more about…” (followed by silence and active listening)
I hope these suggestions help you reflect on how we can use silence, and how we manage interruptions, to help our patients feel heard.
Černý M . Interruptions and overlaps in doctor-patient communication revisited . Linguistica Online 2010 .
Coyle AC, Yen RW, Elwyn G. Interrupted opening statements in clinical encounters: A scoping review. Patient Educ Couns. 2022;105(8):2653-2663.
