Around the world, chaplains provide specialist spiritual care for people with complex healthcare needs. If the nature of chaplain interventions was better understood then multidisciplinary colleagues could both improve their own skills in spiritual care and better understand when to refer people to chaplains. A survey was constructed to establish what aspects of the chaplain/patient relationship were most important for patients in Scotland and Australia. Outcomes were measured with the Scottish Patient Reported Outcome Measure (Scottish PROM^©). Results from 610 respondents showed the strongest correlation was between ‘being able to talk about what is on my mind’ and the Scottish PROM (r_s(452) = .451, p < .0005). ‘Being able to talk about what is on my mind’ proved more important than being listened to, having faith/beliefs valued, or being understood. Given the importance placed on listening and understanding by clinicians, this original and counterintuitive finding goes some way to explaining the unique role and function of healthcare chaplaincy.