When Silence Isn’t Neutral
A Closer Look at Disconnection, Distortion, and the Unspoken in Healthcare
“People talking without speaking,
People hearing without listening…”
— The Sound of Silence, Simon & Garfunkel
In a previous reflection, we explored the gift of silence—the kind that creates space for awe, rest, and human presence. But not all silence is healing. This post explores the other kind: silence that conceals, distorts, or delays what truly matters.
Silence as Linguistic Isolation
“And the people bowed and prayed to the neon god they made…”
Language barriers don’t just block understanding—they create silence that echoes through entire encounters. Over 67 million people in the U.S. speak a language other than English at home; about 26 million are considered Limited–English Proficient (LEP). Though professional interpreters improve care quality, only about 64% of LEP patients receive language support, and many are offered no choice.
In these cases, silence is manufactured. Portals and machine translation tools substitute real conversation—but often misfire. Recent research shows common medical instructions are mistranslated up to 8% of the time in some languages. The result? Increased risk, poorer outcomes, and profound disconnection.
This is silence not from reflection—but from structural design.
Silence as Clinical Distortion
“No one dared disturb the sound of silence…”
In healthcare, silence doesn’t always mean calm. More often, it distorts what we hear and understand. Suppressed concerns, avoided conversations, and misunderstood instructions create a quiet that misleads.
Suppression occurs when patients stop speaking up after being ignored. One poll found that 52% of patients felt dismissed by providers—rising to 60% among Hispanic patients.
Avoidance emerges when clinicians soften hard truths or delay clarity. A moment of discomfort is spared—but uncertainty multiplies.
Miscommunication is shaped by silence that leaves gaps. Studies show patients forget up to 80% of what’s said during a medical visit, and misremember half of what they retain. Even minor misunderstandings can derail outcomes.
Clinical silence isn’t always visible. But its impact is no less real.
Silence by Design
“In the naked light I saw
Ten thousand people, maybe more…”
Some silence is engineered.
It shows up in interfaces without translation. In forms no one understands. In policies that assume access but don’t ensure it. Patients are present—but unheard. Staff are overwhelmed—but left out of decisions.
And so the system appears busy, even efficient. But the silence is built in—from the EHR to the boardroom.
When people aren’t invited to speak, or can’t afford to be honest, we shouldn't be surprised when nothing changes.
The Difference Between Peace and Absence
“The words of the prophets are written on the subway walls…”
Not all silence is harmful. But it’s never neutral. Sometimes it’s wisdom. Sometimes it’s fear. Sometimes it’s exhaustion, grief, or the slow loss of trust. It’s not always clear what kind of silence we’re encountering—unless we stop and ask.
At Storyline, we pay attention to what isn’t said:
The topic a patient keeps skipping.
The question someone avoids.
The pause that’s too long, or not long enough.
Some silence can be healing. But bad silence? That’s something we’re obligated to interrupt.
References
MITRE–Harris Poll (2022): 52% of U.S. patients reported feeling dismissed; 60% of Hispanic patients.
Source: https://www.mitre.org/news/press-releases/us-healthcare-system-failing-patients-mitre-harris-pollEndometriosis UK & BBC (2021–2023): 90% of women with endometriosis reported feeling dismissed or not taken seriously.
Source: https://www.bbc.com/news/uk-56550363U.S. Census Bureau (2023): Over 67 million U.S. residents speak a language other than English at home; 26 million are LEP.
Source: https://www.census.gov/newsroom/press-releases/2023/english-speaking-ability.htmlKFF (2023): About 64% of LEP patients report receiving professional interpretation support; access varies widely.
Source: https://www.kff.org/report-section/2023-linguistic-access-in-health-care/Flores G. et al. (Health Affairs, 2005): Professional interpreters improve care; their absence correlates with longer stays, higher errors.
Source: https://www.healthaffairs.org/doi/full/10.1377/hlthaff.24.2.424Juckett G. (2014), American Family Physician: Patients forget 40–80% of information post-visit; about half is recalled incorrectly.
Source: https://www.aafp.org/pubs/afp/issues/2014/1001/p576.htmlUC San Francisco (2022): Google Translate has a medical mistranslation rate of 2–8%, with some instructions changing clinical meaning.
Source: https://www.ucsf.edu/news/2022/08/421296/google-translate-inaccurate-medical
