Silence, when used intentionally in primary care, can deepen listening, strengthen the therapeutic relationship, and reduce unnecessary medicalization, making it a powerful communication tool for busy clinicians.

“We talk too much in primary care consultations, and silence on the part of the healthcare professional can be a very useful tool,” said Sara Yebra Delgado, MD, second-year resident in Family and Community Medicine at the La Calzada II Health Center in Gijón, Spain. Yebra spoke at the symposium “The Silences of Primary Care,” recently organized by the Spanish Society of Family and Community Medicine (semFYC).

She argued that the conscious use of silence could improve the quality of clinical interviews, promote deeper listening, and strengthen the therapeutic bond. semFYC emphasized that silence appears in multiple clinical scenarios, from patients’ difficulty expressing their suffering due to certain unseen experiences within the healthcare system. Some silences have a therapeutic effect, whereas others contribute to perpetuating inequalities or concealing health‑relevant realities.

In this context, Yebra reminded the audience that how clinicians listen and how patients feel heard depend on training, biases, organizational structures, and power dynamics. Together, these factors directly influence the physician-patient relationship, credibility given to patients’ narratives, and clinical decision-making.

Silence as a Listening Tool

Part of Yebra’s presentation focuses on the role of silence in the consultation room. She described silence as a tool for radical listening, allowing patients to shape their own narratives without interruption, organize their thoughts, and express concerns that may not surface through direct questioning.

She noted that silence helps create an atmosphere of warmth and attentiveness, signalling to patients that their story matters. “Those who ask questions get answers, but only answers,” she said, adding that silence can open the door to information patients may not feel able to share when directly questioned.

These functional silences, particularly at the start of the consultation, encourage spontaneous narration. Yebra said that this approach increases patients’ sense that time is available, improves the quality of the interview, and enhances overall satisfaction, even without lengthening the visit itself. The result is consultations that contain more clinical information within the same allotted time.

She also highlighted emotional containment as a key function. Yebra described this as the clinician’s capacity to receive, tolerate, and accompany emotions such as fear, sadness, anger, or frustration without dismissing or judging them, or immediately responding to medical intervention.

Yebra noted that clinicians see a growing number of consultations driven by emotional distress, much of which falls outside the traditional boundaries of health and illness. In many cases, she said that this distress reflects an adaptive and self-limiting response to life circumstances, shaped by social, work, or family pressures.

In this context, silence legitimizes suffering without automatically leading to medicalization, referral, or prescription. Yebra noted that, at times, simply being heard is sufficient to reduce the emotional intensity of distress.

This form of containment is also valuable in complex clinical situations, such as caring for aggressive patients or delivering unwelcome news. At these moments, silence gives patients the space to process information, express emotions, and sense the clinician’s presence without the need for words.

Legal and Ethical Perspectives

The presentation also addressed silence from legal and ethical perspectives. Yebra recalled that Spain’s Law 41/2002 sets out both the patient’s right to receive information and the right not to be informed. In this context, silence is recognized as a category linked to professional confidentiality.

She warned against the so-called conspiracy of silence, in which family members asked clinicians to withhold relevant information in an effort to shield the patient. While such requests are often motivated by good intentions, Yebra stressed that clinicians must first explore the patient’s wishes and protect their autonomy.

Yebra also reminded attendees that managing silence was a core communication skill in clinical practice. Even under heavy workload pressure, she said that thoughtful use of the first minute of the consultation, combined with eye contact, body posture, and brief pauses, can markedly improve the quality of the clinical encounter.

At the same time, she cautioned that not all silences were therapeutic. In some situations, professional silence can lead to complicity and injustice. Knowing when to remain silent and when to speak, she said, was part of the ethical and professional responsibility of family medicine.

No Absolute Silence

The symposium also featured Mikel Baza Bueno, MD, specialist in family and community medicine at the Zeberio Clinic and head of the Arrigorriaga Primary Care Unit within the OSI Barrualde-Galdakao of Osakidetza, Bizkaia, Spain. Baza argued that absolute silence is incompatible with life, noting that many philosophical and artistic traditions have linked silence to knowledge, wisdom, and introspection, from Plato and Lao Tzu to contemporary music and literature.

Building on this cultural background, family physicians have brought the concept of silence into clinical settings, particularly in primary care consultations. Silence, he said, is present in both patients and clinicians, and its value depends on the context and how it is used. According to Baza, psychotherapy distinguishes between productive, neutral, and obstructive silences as well as functional and dysfunctional silences, highlighting the complexity of silence in clinical practice.

Yebra and Baza reported having no relevant conflicts of interest.

This story was translated from Univadis Spain part of the Medscape Professional Network.