Time-consuming or time-saving?
Like all acoustic phenomena, silence is played out along a timeline. It is easy to believe that using silence is time-consuming, but it makes more sense to consider this time as an investment, rather than as a cost that cannot be recouped. In the long term, using silence is time-saving. Hunskår's textbook of general practice medicine highlights a study from 1984, which shows that on average, the doctor interrupts the patient after 18 seconds (3). By letting the patient speak freely, one can arrive sooner at the heart of the matter. Interruptions in an attempt at efficiency may quickly prove counterproductive. Silence is the ultimate open question.
Giving the patient space in the form of silence means giving the patient recognition
The length of a silence is a strong indication of its meaningfulness. A very brief pause can underscore a point, a somewhat longer pause facilitates dialogue, while the longest pauses provide breathing space after communication of a large amount of information. The longer a pause lasts, the more meaningful, and more weighty, it becomes. How long should the silence last? There is no exact blueprint, and it requires intuition and timing. Already after 0.2 seconds, silence signifies that it is the other's turn to speak (4, 5). Rhetorical silence is achieved after 1–2 seconds, and a silence of 4–5 seconds will often be perceived as an anticipative gesture or a pause for reflection. Silence that lasts for 10–15 seconds is meaningful as a separate element of the conversation, on a par with a statement and with a meaning consistent with how the ground has been prepared and what body language indicates. This kind of silence can be confrontational, calibrating or processing, and all these types of silence have their place as independent meaningful elements.
In our auditory perception we are always dragging a 'tail'. We listen, process, and plan simultaneously. This is key to our understanding of sentences. In the absence of this ability we would hear only the individual words and lose their connection with the other words. Not unexpectedly, it requires more cerebral processing to plan responses during a chat than during a silence (6).
It is common to react to silence with uncertainty. Silence may indicate danger. In a study that explored brain activity during silence, both in conversation and after a musical chord was played, it was found that silence activates the temporal cortex (7). This indicates that the perception of silence is more than a passive process. Silence creates expectation. By letting an attentive silence prevail, we leave room for the patient to choose the direction. It also gives the doctor time to reflect. Depending on body language, silence may also function as a natural closure. In this case, silence will have a clarifying effect (8).