by Dr. Jess Bunin
I was sitting in morning report during residency when I heard a case that mirrored my own unexplained symptoms, and the phrase "pathognomonic for Hodgkin's disease." My face went hot. The room did not go quiet. I did. That forced pause was not chosen. It was unavoidable, the moment momentum breaks because the body insists on being heard.
That pause taught me something about leadership. Pausing is often mistaken for indecision or weakness. It is neither. It is discipline. It creates space between stimulus and response, the space where judgment lives. Without it, leadership becomes reactive, driven by fear or urgency instead of values. There are three kinds of pause, and each does different work.
The tactical pause interrupts reactivity in the moment. It might last three seconds or three days. I used to get defensive at any hint of feedback until a nurse, in a room of a hundred colleagues, corrected me for saying "my nurses." Instead of explaining myself, I said the phrase I had practiced: "Wow. Thank you for pointing that out." That sentence is my tactical pause. Everyone needs one, practiced until it arrives before the defensiveness does.
The strategic pause steps back to ask whether you are solving the right problem. As Chief of Critical Care in Hawaii, I inherited a central line infection rate five times the benchmark, with patients dying from a shared organism. My instinct said hand hygiene. Instead, I widened the room, bringing in everyone who touched an ICU space. An environmental services team member revealed that her contract barred her from cleaning anything with a plug, which in an ICU meant almost everything. It was never a hygiene problem. It was a systems problem, found only because we slowed down enough to ask better questions. Within six months, infections dropped to zero.
The existential pause is the deepest of the three, a step back from role or pace when continuing would cause harm. After two surgeries, chemotherapy, and radiation, mine meant taking real time instead of rushing back to residency, finding a therapist, and naming the depression I had been carrying. Only then was I ready to return.
All three pauses rest on self-attunement, the practice of noticing your own internal state before it spills into the room. Without it, fatigue becomes impatience, fear becomes control, grief becomes withdrawal. None of this makes us bad leaders. It makes us human. But noticing it first gives us a choice.
Pause is not reserved for reflective personalities. It is a leadership competency, one that can be learned and practiced. It protects judgment, teams, and patients. In healthcare, where trust is always on the line, that protection is not optional.
