The “pregnant pause” is a very powerful and simple communication technique. If you practice it and get it right; it will be one of the best things you ever did for your patients and yourself. It’ll help communication in all the facets of your life.
The Pregnant Pause is a subtle non-verbal eye and body movement that says “Thank you for taking the time to listen”. Most doctors never get to experience the pregnant pause because they’re too busy butting in! Sad but true!
I first saw this technique demonstrated by Dr James Carter, the originator and developer of experiential residential retreats for chiropractors. He regards it as foundational to practice success.
Here’s how you get to experience and practice the pregnant pause. You’ll need to have one or several role-play partners; it is best done at a special staff meeting where role-playing can be employed.
First, have one player take on the role of Doctor. Have another take on the role of new patient. Place two chairs opposite each other, WITHOUT a desk between, as you would at the start of a good consultation.
The Doctor has to walk into the room, introduce himself or herself to the patient, briefly, and then let the patient tell his or her ‘story’ till the PREGNANT PAUSE.
Get the ‘patient’ each time to talk about a real or imagined presenting complaint, and after each role-play, get the patient to let the doctor know if they were hurried, cut short… or allowed to finish. You WILL be surprised at first!
The other members of the team can stand or sit nearby and watch the process; they will be required to comment on the process and partake in it themselves later too.
Now, let’s run through a typical pregnant pause practice session.
DOCTOR: knock gently on door. Enter, and make eye-contact with patient as you enter. While holding gaze, move over (don’t rush), shake hands with seated patient, and sit comfortably opposite.
Don’t avert gaze: if you find this difficult, look just above the patient’s brow. (Most people can’t even get this one right at first! Holding gaze has very deep significance for the patient: it is a non-verbal affirmation that the doctor is truly focused on him or her.)
When you’re seated, put any pen or paper aside, and DON’T WRITE… just sit there ready to listen, all ears, with no distractions.
(There’ll be plenty to write later, but before any examination or questioning starts… the patient needs to know that you’ll listen thoroughly. Otherwise you’re “just another doctor who didn’t listen to me”. Most doctors are guilty of this, and it holds their clinical results and practice life back considerably, although they won’t know it until they’ve mastered listening in this way.)
DOCTOR: “Hi, Joan. I’m Dr John. Please… tell me why you’re here.”
(Many doctors naturally use open body gestures such as palm-upward hands and a little nod of the head, with wide-open eyes, to affirm this part.)
Let the patient start talking. And wait until the patient has REALLY finished. Most patients will unburden what they want you to hear in 30 to 90 seconds. Very rarely will they go over. When they see you are really looking, really listening, not distracted, and not jumping in with your two-cent’s worth… they’ll be very satisfied and tell you they’ve ‘finished’ with a pregnant pause.
In fact, many patients say the words “That’s all” when they finish, with a shrug of their shoulders, a nod of their head, and a “What next?” look in their eyes.
Blink and you miss it. Dive in too soon and the patient will feel unconsciously ‘robbed’ by yet another doctor.
DON’T jump in when YOU think they’ve finished UNLESS they’ve given you the PREGNANT PAUSE. I can’t repeat this enough.
Don’t dive in because someone stops talking for a few seconds; they may be thinking deeply while they recall something important. Only speak when they’ve shrugged, given a little affirmative nod of their head, and verbally or non-verbally said “That’s all”.
Once you’ve been given subconscious permission to talk with the pregnant pause, you can ask all the questions you like. To complete the exercise in the best possible style, though, REPEAT EVERYTHING YOU’VE JUST BEEN TOLD BY THE PATIENT BACK TO THEM. Then you can write it all down later, once the patient knows you’ve listened, and you know you’ve got the whole story.
The whole process of entering, holding gaze, introducing oneself, putting aside pen and paper and LISTENING thoroughly will have to be practised several times by most people. Keep the role-play going until the group and the ‘patient’ and the ‘doctor’ agree that they noticed and felt the subtle ‘permission-giving’ shrug of the pregnant pause.
I guarantee you’ll find this seemingly simple little exercise a lot more challenging, fun, and insightful than it appears in the written form. Make sure everyone has a go at being patient and doctor, and that everyone is critiqued by the group.