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In trying to improve clinician communication skills, we have often heard clinicians at every level admonished to ‘‘use silence,’ ’ as if refraining from talking will improve dialogue. Yet we have also noticed that this ‘‘just do it,’’ behavior-focused ‘‘use’ ’ of silence creates a new, different problem: the clinician looks uncomfortable using silence, and worse, generates a palpable atmosphere of unease that feels burdensome to both the patient and clinician. We think that clinicians are largely responsible for the effect of silence in a clinical encounter, and in this article we discuss what makes silence enriching—enabling a kind of communication between clinician and patient that fosters healing. We describe a typology of silences, and describe a type of compassionate silence, derived from contemplative practice, along with the mental qualities that make this type of silence possible