Waiting for Silence — What Happens in Patient Interviews (After CST)

I knew the skills necessary for patient interviews in theory, such as from palliative care workshops.

・Make eye contact while speaking.
・Wait for the patient to speak.
・Allow for silence.
・Use open-ended questions.
・Offer words of comfort.

And so on.

However, while I understood these concepts, to be honest, I did not feel I was practicing them with any real confidence.

Several years ago, invited by a senior doctor who mentored me when I was young, I participated in a Communication Skills Training (CST) workshop held by the Japanese Psycho-Oncology Society.

It was a two-day residential workshop. The participants were a small group of about five doctors and dentists with a certain amount of clinical experience.

We performed interview simulations with standardized patients over and over again.
These standardized patients were quite tricky (no offense intended!), transforming into various characters, from a country grandmother to a highly educated woman.
Sometimes they would throw harsh words at me, and other times my words wouldn't reach them at all. They were truly formidable opponents.

After each simulation, we would reflect and identify problems and challenges. We repeated this process many times.

At first, it felt somewhat like acting, and I couldn't really get into it.
However, as we repeated the sessions, I gradually became more engaged, and before I knew it, I was facing the patients as if I were actually on the ward.

During that time, I began to understand the meaning of these skills and the patients' reactions to them through my own experience.

For example, silence.

It is not just about staying quiet.
When you watch the patient's expression, there is a moment when their confusion turns into a resolve to continue speaking.
You wait for that. Whether it takes 30 seconds or 3 minutes.

Silence is not something to be feared; rather, it becomes a precious time.

By repeating this over and over, I felt that what I had known only as words on a page was gradually becoming a part of me.

By the end of the two days, I was exhausted.
Even so, I felt fulfilled. There are not many workshops that have given me such a sense of fulfillment.

I believe that through this experience, my mindset when facing patients has changed.

Make eye contact while speaking.
Communicate in concise language.
Show a willingness to walk alongside them by grasping their thoughts through silence and empathy.

Depending on the interview with the doctor, a patient might feel hope, pessimism, or even despair.
The doctor's words can change a patient's prognosis, and sometimes, they might even influence the course of that person's life.
To me, this is, in a sense, terrifying.

Patient interviews require a corresponding level of resolve.
And for that, daily study and practice are indispensable.

I am still on that path myself. I have many regrets.
Even so, I face my daily clinical practice while reflecting on my experience at CST.