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A Piece of My Mind
July 9, 2019

The Sound of Silence—When There Are No Words

Author Affiliations
  • 1Department of Surgery, Mission Hospital, Asheville, North Carolina
JAMA. 2019;322(2):117-118. doi:10.1001/jama.2019.8385

My father was killed by an Islamic fundamentalist in Cairo, Egypt, when he was just 47 years old. It was October 1993, exactly 8 months following the first World Trade Center bombing. I first heard the news from my uncle; I screamed—a feral howl escaping from deep inside of me—and dropped the phone.

Terrorism was still a new word and a new concept for many Americans, so my father’s death was featured prominently in the national papers and on the evening news. What does one say to a teenager whose father was just shot by a madman screaming “Allahu akbar?” Nobody knew. I didn’t know. The silence was incredibly isolating.

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1 Comment for this article
Silence in China
Cong Hu, MD | Department of Critical Care Medicine, Zhuhai People's Hospital,The Third Affiliated Hospital, Jinan University, Zhuhai, Guangdong 519000, People's Republic of China
For me, as a Chinese doctor who has worked in the ICU in my life and clinical career, I also have a deep understanding of the therapeutic value of silence. When communicating with family members of ICU patients, there is often excessive grief among family members. Silence gives others the opportunity to express themselves and be heard, although people sometimes are too emotional to express themselves in words. Sitting quietly with patients and their families sometimes indicates the therapeutic value of silence. When I can't speak, I can only sit quietly beside patients and their families and listen as the author does.

I would like to comment on silence from the perspective of a Chinese ICU doctor. Appropriate silence is a good way to solve the current extremely tense doctor-patient relationship in China. it conveys your concern and responsibility to patients as well as the understanding and sympathy of patients' families, but sometimes it does not. Inappropriate silent expression may make family members of patients feel that you don't know enough about the patient or are not responsible enough, leading to potential doctor-patient disputes. Therefore, the way of silence should be paid special attention to in education and clinical work. In short, silence provides a very good way for a healthy doctor-patient relationship.