It was a busy day at work in my emergency department in New York City. I picked up a patient who had been waiting three hours to be seen. A brief glance at her triage note said she was here for chest pain, without much more detail included. I did a quick chart review and noticed that she had never been seen in our hospital. She had a nearby address listed as her home, and it stated her preferred language was English.

After some searching through our crowded ED , I found her sitting in a chair, patiently waiting. She smiled as I approached and introduced myself with my usual, “Good afternoon, my name is Vanya, I am going to be your doctor today. How can I help you?”

A smile and a pause.

“No English… Spanish?”

I smiled back and quickly repeated myself, this time in Spanish. “Si, hablo español. Buenas tardes, me llamo Vanya, voy a ser su doctor el día de hoy. ¿Cómo le puedo ayudar?”

We went on to discuss why she had come to the ED . I learned she had recently moved to New York from Ecuador and was living with a friend in a nearby apartment. Her visit lasted a few hours, and after some labs and imaging, she went home with a referral for a primary care doctor at our hospital.

As she left, I wondered: How many people had spoken to her in English without realizing she could not understand them? How many papers and flyers and forms had she been handed that she could not read? Had those before me who could not speak Spanish called an interpreter when speaking with her?

For our patients with limited English proficiency (LEP), we are required by state and federal law to provide language access services.^1,2 In New York, for example, we must provide an interpreter within 10 minutes of a patient or their family requesting assistance in the emergency department.³ The law also states that translations and transcriptions of significant documents and instructions must regularly be made available.

How are we doing with this?

Overall, we could do better. Studies have shown that we are consistently failing to properly document patients’ language preferences in their chart and provide certified interpreters for patients requesting help.^4,5 We often lean on family members as interpreters when we are in a crunch or have something quick to discuss with a patient. We are falling short in providing proper discharge paperwork for our patients in their requested language and reviewing it with them using a certified interpreter. The list goes on and on.