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.

Yet I am not here to scold us.

Have I used a family member as an interpreter before because I did not want to take the extra three minutes to pull up the interpreter on my phone and provide them — for the 10^th  time — with my name, location, and my patient’s medical record number? Yes. Have I used Google translate to prepare discharge instructions and handed them to a patient without calling an interpreter to review them verbally? Yes. Have I held up my phone with a short phrase translated into another language to have my patient read and respond with a nod or shake of their head? Yes.

I am only human, as we all are.

We work in chaotic environments where we are flooded with patients and their concerns, often asked to perform more tasks than are humanly possible to accomplish in a 12-hour shift, and we do so with limited resources. Every day there is a new rule or regulation or hospital policy put in place that we attempt to file away in our already oversaturated brains. We cannot possibly be perfect and do everything exactly as it should be done.

Yet this matter, the fundamental communication between doctor and patient, should not be  skipped. The ability to listen to and understand our patients is vital; they deserve to understand what we are saying. This is not the place to cut corners or worry about extra time and effort. This is where we must place our energy.

My point being?

Take a few extra minutes when working with your patients who speak another language. Check that their language is properly documented in the chart. Familiarize yourself with all the ways in which you can get an interpreter in your workplace. (For example, we have a phone number we can call and have a few video tablets available). Document your interpreter use. Be prepared to call an interpreter when you review results, give updates, and provide discharge paperwork.

Communicating and the art of language is just as much a part of our job as knowing the differential diagnosis and ordering the proper diagnostic studies. Remember that as you continue picking up patient after patient, you will become a better physician and one who is learning to listen.

Dr. Zvonar is a third-year resident at The Mount Sinai-Elmhurst Emergency Residency Program in New York City.

References

1. S. Department of Justice, Civil Rights Division.Title VI of the Civil Rights Act of 1964, 42 USC § 2000d et seq. Accessed September 23, 2025.
2. S. Department of Health and Human Services, Office for Civil Rights. Nondiscrimination in Health Programs and Activities; Title VI and Section 1557 Language Access Requirements” (Final Rule). 45 CFR Part 92. Federal Register. Published May 6, 2024. 89 FR 37522.
3. New York State Department of Health. Patients’ Rights, 10 NYCRR § 405.7. Accessed September 23, 2025. https://www.law.cornell.edu/regulations/new-york/10-NYCRR-405.7
4. Taira BR, Orue A. Language assistance for limited English proficiency patients in a public ED: determining the unmet need. BMC Health Services Research. 2019;19(1). doi:https://doi.org/10.1186/s12913-018-3823-1
5. Ginde AA, Sullivan AF, Corel B, et al. Reevaluation of the effect of mandatory interpreter legislation on use of professional interpreters for ED patients with language barriers. Patient Educ. Couns. 2010;81(2):204-206. doi:https://doi.org/10.1016/j.pec.2010.01.023