Silence is the mental space in which the patient may be him/herself.
In a previous column you could read about the importance of empathy. An empathic doctor does not need to be convinced of that. A non-empathic doctor does indeed, because for him it is, by definition, just not very real. That creates a paradox: this text is especially written for who initially sees little to no benefits in it. I give to these the advice: look for something else, even and especially if this ‘something else’ seems nonsense to you. Does the way forward seem softy? The final destination is not, because it is, to a great extent, really about the health and well-being of your patients. I have no hesitation to claim (and not only me): your empathy is often more important than your strictly medical practice. Your empathy also determines your strictly medical practice.
Promptly a bull’s eye. Have you heard about Silence in your training? I haven’t. Perhaps some students would run out of the classroom, screaming. Or perhaps not. What can prevent them from doing so is either youthful idealism or the wisdom of maturity. I sincerely hope that you are either youthful or mature enough (or at best, both at the same time) to continue reading.
Silence may be prolonged or it may be momentary or even no silence at all. Silence is in fact something else. It is the silence behind the words, that may sometimes come to the fore between the lines, and sometimes also in very short pauses between words. Do you understand?
In principle, Silence is underlying. If you listen, it is always present.
It is the color palette on which the words of the patient get meaning, beyond their mere information value. A litmus test of your attention for silence may occur if there is suddenly a real silence. Do you feel uneasy? Is it a ‘painful silence’ that you are trying to fill with words or actions: filling merely in order to fill? Then you are not in contact with the Silence of the patient. Does, however, a little real silence feel like that spot where you reach a turning point in understanding, motivation, compliance, even the evolution of the patient? Congratulations!
Silence is the space in which the patient may show him/herself.
You are – hopefully – an important figure in the life of the patient, also at a symbolic level. Even if he/she sees you for the first and perhaps the only time. You symbolize the pursuit of health. So not only the reduction of symptoms, but a really completely good health. If the patient gets Silence from you, you give him the space he needs to work on his own health.
This translates at first place into a good and efficient anamnesis. The patient will more quickly tell you the things that really matter and would otherwise only come to the surface after a certain time, or not at all. An allergy one used to suffer from. A potential genetic predisposition. A reason why the patient will not take the medication you prescribe. An indication that the patient would benefit more from a psychological approach to his problem… Otherwise you might ignore it for a long time. It might possibly cost you a lot of time and frustration, to the patient lots of misery, to the RIZIV much money, and so on… Silence leads to a better somatic treatment. Silence also leads to the patient’s gratitude for your empathy. And so it also aids to improve your job satisfaction.
As with other factors of empathy, it is important to point out that, eventually, Silence costs you little to no time. If you use it right, you will even save time. If you would have too much time on your hands though, you can of course also seek the Silence in effectively allowing a longer-lasting period of true silence. In that case, it is interesting to ensure that you do not think being deprived of your time because of this.
Real Silence is something by which you yourself cannot lose anything.
On the contrary, you get something priceless: the feeling and the knowledge that you really mean something to this person. He will always remember who you were. The person who makes time for Silence, will thus overcome time itself in this special way.
And you will sleep better, in case this might otherwise be a problem.