Communication Considerations

BJ Miller, MD
3 min readSep 8, 2021

Communication is more than just what you say.

Holding Silence

Silence is really difficult and really important. Holding silence does not mean simply talking more slowly but actually being quiet, taking a deep breath and allowing your nervous system to settle. Doing this puts you in a better position to think through what’s coming out of your mouth. Silence can get awkward, but it’s an awkwardness that pays off in the long run. Therefore, don’t be afraid to be silent in conversations often and to hold silence as long as you can.

Body Language

Our words hold meaning and are important, but the majority of what you’re communicating and expressing has to do with body language. We say a lot with our bodies and, therefore, it is important that we use our bodies to communicate what we desire to say. Pay attention to your body. Get into your body. Breathe into your body. This will reset your nervous system as well as allow you to transmit your message to your audience more faithfully.

Putting Words Into Writing

There are many ways to communicate. The medium of communication can be vitally important. Talking together digitally, for example, has its own peculiarities. Sitting down at a table facing each other can be a bit confrontational. The setting matters. The environment matters. The medium matters.

What I often find myself recommending to people is that if you want to say something to someone and are struggling to find the words, is to write a letter. There is something very powerful about letter writing. Writing a letter and putting all of your feelings onto paper can be quite cathartic and, on the receiving end, receiving a letter allows the reader to re-read the text, hold the paper and sit with what was written. Mylastingletters.com is a website that helps people draft letters in times of need and may have some great resources for you.

The Where Matters

Another trick is changing the setting. Sometimes going for a walk or drive can be very powerful. Many times people, especially teenagers, will open up on a drive because they are facing a different setting, have plenty to look at, and you’re sitting side by side rather than facing each other. It’s amazing what can come out in conversation in this form.

Asking for What You Need

Demonstrating what needs to happen with passive aggressive actions instead of saying what needs to happen is a common mistake of communication. Sometimes you have to be very direct, to the point, and straightforward. Even if you think you’re implying your point, you may need to ask instead of communicating indirectly or passively with your actions. This is a vitally important key of good communication practices.

Try to be direct as often as you can. Sometimes, with the nature of language being what it is, the most direct way to talk is through metaphor or analogy. However, if you find yourself deliberately masking what you’re trying to say with metaphor, this may present a problem with your audience. The beauty of communication, however, is that you can always ask your audience whether or not they heard what you said and ask them to repeat it back to you. This may feel as though you’re plodding, but ultimately this may be the kindest thing you can do and ensures that you are communicating effectively with your audience.

Expect Miscommunication

Start with the assumption that there will be difficulties with communication. Assume that miscommunications will happen and are happening. The process of figuring out what you think, articulating those thoughts into words, and then expressing these things in a way that will be well received is an art. There are so many ways this process can go wrong. Communication is funny, awkward, basic, and human. As with all human activities, difficulties and challenges are going to be part of the natural process.

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BJ Miller, MD

BJ is a hospice & palliative medicine physician who sees people at mettlehealth.com and speaks on topics of illness and palliative care around the world.