Small Talk at Dawn

Lessons from the wards on how to talk to people and like it!

Oliver Bateman is right in his recent viral essay: society runs on phrases worn smooth “like river stones,” their content less important than the cushion they offer between strangers. Yet this is not a lamentable fact, this buffer allows for a social grace without requiring the full weightiness of self-expression and sharing too much.

To this end, small talk is an art—an elegant means of slipping into and out of conversation. It’s the opening choreography of any human interaction, those first few steps where we may silently ask: do I want to keep dancing with this person?But in the hospital, there’s no such question. This is a job. You must dance with every patient. The subject matter is often grave, the tempo uneven, and the partners not fully prepared. Here, small talk isn’t a prelude. Rather, it’s a synchronizing beat. A way to get two people moving in time before the full weight of the waltz begins.

Before sunrise on the ward, physicians move through familiar steps. Yet something strange and beautiful happens. The linguistic handshake, so often a hollow formality, becomes, within these walls, a slender but sturdy bridge across very real suffering. A smile, a weather comment, a joke about the coffee—these are never empty gestures. They are tools, gentle ones, that make the harder work possible. They exist to be, as Bateman puts it, “reaching out across the void of presumed incommensurability that separates all of us,”

I’ll admit it up front: I actually enjoy small talk. I’m an extrovert, and novelty excites me. What could be more novel than meeting someone new?

But I will also confess I wasn’t always good at it. If anything, clinical rotations have been an honors course on the subject. Watching masters of bedside manner move from room to room, each patient a little lighter for having seen the doctor, has taught me how to be a better dancer, so to speak.

These are a few of the lessons I’ve picked up—observations for anyone hoping to improve their general small talk or their bedside manner for the medically proficient. In the hospital and beyond, the dance is worth learning.

Cross the Threshold

The first step in dancing with someone is, of course, asking them to dance. Trivial as it sounds, this requires some degree of bravery to initiate the conversation, especially because there is the possibility of rejection. I found Bateman’s line incredibly astute, “The masters of social interaction understand that most human communication isn't about exchanging information. It's about establishing comfort.”

The first question “How are you, this morning?” is pure formality. In a hospital room, when our objective is to get some medical facts from the patient, then pass our plan to the patient, all in a timely manner (before doing it again with the next patient), there is an impulse to dive into the objectives. But the form of the opening moves still matters.

The patient may be waking up or was just watching something on the dim hospital television and so asking them that first question, among other things, completely recalibrates their expectations in that moment.

Just stand at the foot of the bed and you are a clipboard with a pulse. But, step forward, let the patient see your eyes, offer a smile, and the choreography shifts. Point to an untouched tray: “The pancakes lost the morning battle?” Small, safe, almost trivial—yet it shifts the patient from passive object to conversational partner who can tell you why they skipped breakfast and, by extension, why today may not go well.

Politeness often ends in reflexive deflection: “It is what it is.” When a patient asks me how I am, I answer truthfully but lightly. “Running on one cup of coffee, but the sunrise was worth it.” Vulnerability, even an ounce, levels the floor. In medicine, revealing a single thread of your own life invites a patient to tug on it and reveal the fabric of theirs.

And its these two essential skills, offering a curious observation and disclosure that allows you to full cross the threshold before jumping into the medical conversation.

Ask, Then Listen

The troubling truth about small talk is that, more often than not, it vanishes without a trace. It begins, it ends, and carries no memory into the future. That isn’t necessarily a flaw. In fact, there’s value in not holding onto too much.

Asking someone on an elevator if they’re glad it’s Friday doesn’t really matter. And if I made a point of remembering that every stranger tells me they’re looking forward to the weekend (even if I’m working tomorrow, and it doesn’t feel like a weekend to me) then maybe I’d need to ask for their name, commit their face to memory, and carry that weight around.

But that’s not the point. Small talk isn’t about building archives. It’s about continuity. Having a next question ready keeps the moment afloat just long enough for both of us to step off the elevator and say, without awkwardness, “Have a nice day.”

There’s a reason not to force these moments into permanence. Small talk is a kind of social blessing, lightweight, sincere, and fleeting. It’s a quiet way of saying: I see you, and even in this passing moment, I hope the best for you.

But when it’s all rehearsal, when every exchange becomes a mask, and people plan their next line instead of hearing the one being spoken, small talk turns deadly, especially at the bedside.

Studies show doctors interrupt patients after just eighteen seconds. They’ve got a plan, a list, a clock ticking. But I’d challenge you: give a full minute of silence. One minute, without interruption. That’s when the patient will mention the night sweats, the misplaced dentures, the real reason they rang the call bell at 3 a.m. The small-talk opener, “How did you sleep?” isn’t filler. It protects you both from diving in too soon. But when timed right, it dissolves, and the real story surfaces.

Because the relationship between a patient and provider is not the same as two strangers locked in an elevator—it’s deeper, more asymmetric, more sacred. And paradoxically, that means there should be more small talk, not less. It buys space, it defuses fear, it gives shape to an experience that otherwise feels like internment.

For the patient lying in bed post-surgery, one remembered detail, a granddaughter’s birthday or a favorite basketball team (Duke or UNC, take your side), can turn the next morning’s visit into proof of personhood and acknowledgment of our shared human dignity.

Then, when you ask, “Tell me what you think?” the words ring sincere because yesterday you proved you were paying attention.

And while it’s easiest if you care for people naturally, not everyone arrives at medicine with that disposition. That’s okay. The chart exists not just for clinical numbers but for reminders: digital sticky notes about what matters. Small talk is the first line of the story. If we write it down, we can pick it up again tomorrow and pick up the person along with it.

Can This Be a Game?

Dancing is more enjoyable when the goal isn’t to impress the whole room, but simply to enjoy the evening. Much the same can be said for conversation. If small talk feels like a chore, maybe it’s time to treat it like a game.

Introverts often freeze at the thought of endless chit-chat. One quiet way to make it more bearable (and maybe even fun) is to set secret goals known only to you. In high school English class, our mandatory Socratic seminars often felt tedious, especially when few had done the reading. To pass the time and sharpen our wit, a few friends and I created a competition. We’d each bring a list of high-flown vocabulary words (dialectic, teleology, juxtapose, ephemeral) and see who could smuggle the most into the discussion.

You can do the same in more grown-up settings. With patients, for instance, I’ve found it helpful to set small, personal challenges: go sixty seconds without interrupting; earn one sincere laugh; ask about a family member; offer an honest compliment—perhaps admiring the pride a patient takes in her hair routine, even while recovering in a hospital bed.

These micro-goals don’t cheapen the encounter. On the contrary, they transform routine into curiosity, repetition into presence. From the outside, the interaction may still look like river-stone chatter. But inside, it becomes something else—livelier, warmer, more sincere. After all, conversation, like dancing, becomes far more joyful when you stop trying to dazzle and instead learn to move in time with someone else.

Our Advantage

Perhaps the clinician best at small talk I’ve ever worked with is a neuroradiologist. In a specialty often deemed first on the chopping block in the age of AI, she offers a strong rebuttal. Patients adore her. She walks them from the waiting room to the CT scanner for lumbar punctures, helps manage their pain, and somehow recalls where they last dined. She trades restaurant tips, remembers birthdays, and focuses wholly on the person beside her. In an age of automation, her attention is an edge no algorithm can match.

Large language models can churn out progress notes and polite pleasantries faster than any seasoned attending, but they cannot risk embarrassment. That’s where small talk lives: in the fragile charm of a corny joke, a mispronounced name, a candid confession of fatigue. Risk signals sincerity. Until silicon can blush, human clinicians keep our advantage.

Bateman’s insight is sharp: honest answers would grind polite society to a halt. And in the hospital, we don’t want full confessions at every turn—the work would become unbearable. Instead, we use lightness to feel for the seam, the place where real pain presses through. When we find it, we lift a corner of the burden, just for a moment, then step gently into the next room and the next ritual. We transform this job from mere providers of medical services into a profession and even a vocation.

In the near future, at 5:45 a.m., I’ll walk into another dim room, note the live weather channel, and begin with “words that mean little but serve much.” Somewhere between the untouched pancakes and the charted potassium, the patient may offer a truth the world outside never hears. That is the paradox we must walk: the emptiest phrases are often the only path to what is full. In the hospital, dancing that path well is not ornament. It is medicine.

Photo by National Cancer Institute on Unsplash