The sounds of silence: exploring lessons about silence, listening, and presence.

Unless we-in our professional and nonprofessional roles-learn the importance and practice of deliberate silence, engaged listening, and restrained response, we will miss the opportunity to provide our presence and comfort to those about whom we care. And unless we-as health care professionals-learn these lessons, we will miss the opportunity to do all of that and provide a more accurate, complete diagnosis and informed plan of treatment. Done well, these practices have application to all our relationships with patients, colleagues, family, and friends. For the 1967 movie, The Graduate, Paul Simon and Art Garfunkel's score included their song, The Sound of Silence. Among the lyrics are these haunting words: People talking without speaking, People hearing without listening . . . . . . And no one dared Disturb the sound of silence. "Fools," said I, "you do not know Silence like a cancer grows. Hear my words that I might teach you, Take my arms that I might reach you . . ." (Simon, 1966)1 The song is full of wisdom about the role of silence, listening, presence, learning, connection, and absence of connection; in other words, how we relate to each other. It's more than coincidence that one definition of music includes reference not only to sounds, but also to a combination of sounds and silence, and that's what this essay is about. Actress Vanessa Redgrave, interviewed recently for The New York Times during her role in the Broadway revival of Driving Miss Daisy, reflected on the importance of listening-not only how the audience listens to the actors, but also how the actors listen to each other: If you don't listen, as Miss Daisy struggles to, you miss the nuances of what others are saying. . . . I've certainly taken it as something I've worked on myself-listen, listen, listen, really listen. You think you're listening, but you really have to work at it. [italics mine] (Healy, 2011, p. C1) And to listen, one has to be silent. Silence is an intentional act. In The Human Side of Medicine: Learning What It's Like to Be a Patient and What It's Like to Be a Physician, I wrote about another dimension of silence and listening: When her elderly mother complains to her about her problems, my friend asks, "Are you telling me this because you want advice, or because you want me to listen?" Sometimes, the patient needs neither answer nor remedy, but simply someone to listen with respect and without interruption. A patient told me, "To have someone who listens and gives thoughtful, trustworthy advice is a blessing. When I have a physician who listens, it's magic." (Savett, 2002, p. 34) Listening requires silence. Sometimes, nothing else is required other than an expression of understanding and validation of feelings. To listen, one must be present, not distracted, thinking about something or someone else; focused and reflective, not only on what is said, but also on the feelings behind what is being said. And one must be silent, in order to listen without interruption. That's a tall order. Silence takes practice. Some, but not all, laypeople are good at it. To be a really good nurse, physician, social worker, member of the clergy, or other clinical health care professional, being silent and listening are essential skills. Here's why. THE SOUNDS OF SILENCE Silence as a Way to Gather Information To learn about patients and their illnesses, we need to hear their story. The patient's story . . . holds most of the clues to diagnosis and treatment. More than any single laboratory or x-ray test or even the physical examination of the patient, the patient's story gives broad and valuable information about what's wrong. (Savett, 2002, p. 11) The initial open-ended question, "What brings you to the hospital (or office)?" allows patients to tell their story: what really happened and the associated feelings, emotions, reflections, and impact on the patient and family. …