Silence as a discourse regime in professional interactions within hospitals

In social science and medicine, silence is frequently mentioned in studies of interprofessional interactions or physician-patient relationships, yet it is most often treated as a secondary phenomenon or a deficit in communication. Consequently, the interactional norms governing silence and its role in organizing professional interactions remain underexplored. This study addresses this gap by examining silence as an object of analysis in professional activities. Based on ethnographic observations and semi-structured interviews conducted in a hospital specializing in severe liver and pancreatic diseases, the study analyses how silence is produced, regulated, and enacted within situated professional interactions. Drawing on Foucault's theory of the order of discourse combined with an interactional perspective, we show that silence in hospital settings is not an absence of communication but a codified, context-dependent mode of regulation shaping how speech circulates between professionals. Our findings show that silence operates differently across interactional settings. During medical staff meetings, it regulates turn-taking and filters contributions according to their relevance for therapeutic decision-making. In the operating room, silence is tied to the spatio-temporal organization of surgical activity, functioning as an interactional resource supporting coordination, concentration, and the management of clinical risk. By conceptualizing silence as an interactionally accomplished discursive regime rather than an individual failure to speak up, this study extends research on voice and psychological safety by showing that silence is not only shaped by social and organizational dynamics but also by discursive regimes that structure the circulation of speech, professional authority, and expertise in hospital work.