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When Anthony Back, MD, a palliative care specialist at the University of Washington in Seattle, takes medical trainees on his rounds, they often come out of the exam room with the same observation: “You didn’t say anything.”
Back is among a growing number of physicians who practices silence with his patients, intentionally giving them more time to share and process before he chimes in, and teaching the next generation of doctors to do the same. After more than a decade the occasional pause is just another tool in Back’s toolbelt. But to his trainees, those gaps can feel painfully awkward –– the opposite of what they’ve been taught.
Medical school “anti-trains you” to practice silence, Back said. Medical schools teach students to be vocal and decisive; poignant questions, swift assessments, and confident answers are rewarded. Silence, on the other hand, can feel like a failure –– a sign of incompetence or uncertainty.
But emerging evidence and educator experience suggest that silence is not an absence of skill but a deliberate diagnostic and relational tool. Silence can invite patients to reveal what structured histories miss and build the human connection that modern medicine so desperately needs. With a few simple but intentional changes, doctors at any level can bring the power of silence into their practice.
About Medscape Insights
Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, the State of Primary Care in the US Report 2026 found that:
- About 3 in 4 primary care physicians (PCPs) gave the quality of patient care a C grade.
- Patients tell their PCPs they don’t want to just leave with a list of recommendations but rather be understood so those recommendations make sense to their values and lifestyle.
- 20% of PCPs surveyed said they need more time for patient consultations.
Silence as a Tool
While silence can feel like the opposite of clinical confidence, it actually has the potential to increase medical accuracy.
Often, the time constraints of clinical visits combined with the physician’s earnest search for answers can drive the medical interview into a list of fast-moving questions, Back told Medscape Medical News. A 2018 study reported that after asking patients about their concerns, doctors only wait an average of 11 seconds before interrupting them.
When the visit goes this way, “the patient [may] miss saying something that could have been diagnostically important or could have given you a crucial piece of social context or another symptom that would help you understand what’s going on,” Back added.
Instead of hyper focusing on the symptoms and clinical factors –– which are undoubtedly crucial –– Back advises trainees to consider their patient as a whole person in the interview, emotions and all. Does the patient appear to be thinking? If so, he uses that silence to give them more time. Do they appear anxious or awkward? If they do, he prompts them with warm encouragement and then gives them the floor.
“I often frame it as getting the patient more space” rather than just being quiet, Back said. Often, patients are so aware of the doctor’s time limits that they feel the need to hurry, rush through their spiel, say less, or be as concise as possible. Silence offers them room to share and lets them know that a provider has time for them.
Doctors won’t need to practice silence for every question or even in every visit. “You don’t have time for that,” Back said. And some visits really are straightforward. But silence is a tool in the diagnostic belt. The key as a doctor, he said, is to be mindful of the moment and the person in front of you. “Leaving some space and silence, so that they don’t feel rushed, that can feel to a patient like very supportive,” he said.
A Safe Space
Silence is also a relationship and trust builder after diagnosis.
It should come as no surprise that palliative care specialists, like Back, who tackle some of the most challenging human conversations around pain, death, and dying are also the early adopters of practicing silence.
“There’s a tendency, when there’s a lot of emotion in the room, to start answering emotions with facts,” said Susan Block, MD, palliative care specialist and professor at Harvard Medical School in Boston. But the reality is that sometimes there aren’t good answers, or the patient isn’t looking for them.
“Silence allows you to hold space for human emotion, in what can be very fraught encounters around healthcare,” Block said. “And also, sometimes it allows me to hold space for my own emotion, whether it’s uncertainty about what question to ask next or feeling deeply sad.”
The trust-building effects of silence go beyond a tough diagnosis, though. More than ever, patients are coming to doctors with lots of information and misinformation, largely due to social media. While it may be a doctor’s first inclination to quickly dismiss the patient’s TikTok research, “that actually just makes patients feel like they’re being rejected,” Back said. And it adds to a growing sense of distrust in the medical system.
Giving a patient narrative space to be heard can make them feel valued, which goes a long way in getting them to hear you when you do need to point out some misinformation, he added.
Where Silence Goes Wrong
It’s critical to note, however, that silence is a far cry from doing nothing or staying quiet. The goal isn’t to simply stop talking for a predetermined amount of time per visit. It’s not even to create an awkward silence that forces patients to talk. In fact, these approaches can have the opposite of the desired approach.
In a 2009 study, the authors wrote, “this ‘just do it,’ behavior-focused use of silence creates a new, different problem: the clinician looks uncomfortable using silence, and worse, generates a palpable atmosphere of unease that feels burdensome to both the patient and clinician.”
When doctors just stop talking, patients feel like they’re doing something wrong, said Tyler Cymet, DO, chair of medicine and primary care at Illinois College of Osteopathic Medicine in Chicago, who teaches medical students how to interact with patients. It can make them feel hurried or punished. It can cause them to retreat.
Instead, effective silence should feel like an invitation to patients. Warmth, encouragement, active listening, and repeating what the patient said back to them are all ways that doctors can make the patient feel comfortable enough to fill the silence, Cymet added.
Similarly, Block tries to make comments that take the pressure off. She says things like “we have lots of time” or “take your time, we can talk about this when you’re ready.” Sometimes it’s clear that a patient can’t find the words to speak up. So she asks, “Can you tell me what thoughts are going through your head right now?” Other times, especially during hard conversations, she allows patients to take the quiet moment, and she simply takes their hand to let them know she’s with them.
Silence Is a Practice
All experts agree that any doctor can incorporate silence into their practice. But it’s not something that can be learned from a lecture, a conversation, or a book.
It must be practiced. Students adopt it best with observation, reflection, and feedback, Block said. They practice using silence and gauging the patient’s emotional status, and afterward they reflect on it with their attending and get some feedback. This allows them to calibrate their communication to someone more experienced with patient emotions.
For practicing doctors, universities like Temple, Wake-Forest, and Lenoir-Rhyne offer narrative medicine certificates that help providers improve their empathy and more effectively elicit patient stories.
Back added that mindfulness –– or the doctors attention capacity and ability to stay present –– also goes a long way in developing the skill of silence.
“You’re supposed to be multitasking; you’re supposed to be writing your notes and thinking about the diagnosis and paying attention to the patient and all this stuff. And there are times, you have to be able to, as a doctor, switch into a mode where you stop everything else and just put all your attention on this person,” Back said. “If we can do that once during every encounter, people would feel differently.” They’d feel heard, listened to, and understood.
Donavyn Coffey is a Kentucky-based journalist reporting on healthcare, the environment, and anything that affects the way we eat. She has a master’s degree from New York University’s Arthur L. Carter Journalism Institute, New York City, and a master’s in molecular nutrition from Aarhus University in Aarhus, Denmark. You can see more of her work in WIRED, Teen Vogue, Scientific American, and elsewhere.
