In reply to O'Rourke and Gruener.

Drs. O’Rourke and Gruener present a compelling example of good practice: hospital and training program leaders recognizing that language proficiency is a learned skill, and ensuring that providers are competent to use language skills safely and effectively with patients. The inclusion of a structured clinical assessment is noteworthy, and emphasizes that effective communication is the foundation for patient-centered medicine. Our own experience supports the principles advocated by Drs. O’Rourke and Gruener.

Despite regulatory requirements and the availability of tools to measure language need and service delivery,[1] hospitals and health care providers often choose untested family members, friends, or providers to meet the communication needs of limited English proficient families.[2] As Drs. O’Rourke and Gruener note, medical Spanish courses are helpful, but may have unintended consequences if nonproficient providers conclude they no longer need an interpreter after completing such a course.[3] Failure to use professional interpretation can lead to miscommunication and medical errors.[4] Further research is needed to determine whether rigorous language training for medical providers can safely and effectively build language proficiency.

Like Drs. O’Rourke and Gruener, we have witnessed a promising change in our institution’s approach to providing bilingual care. Our findings encouraged our hospital leaders to adopt a language proficiency certification process. Seattle Children’s Hospital requires that faculty, residents, students, and staff who wish to use non-native language skills with families pass a telephonic assessment of clinical language skills. Those who pass receive a colored placard in their badge holder, announcing the language spoken. We have noticed a shift in hospital culture towards recognition that only certified proficient language skills should be used with patients and families; otherwise, professional interpretation is needed. We also recommend that proficient providers consider professional interpretation for complex or difficult conversations to ensure that subtleties of meaning are not lost or misconstrued. Recognizing the crucial role communication plays in the art of medicine, and our own limitations, is essential both for delivering optimal care to each patient, and for training the next generation of doctors.