Language barriers in medicine in the United States

What the scalpel is to the surgeon, words are to the clinician... the conversation between doctor and patient is the heart of the practice of medicine.1 The physician-patient relationship is built through communication and the effective use of language. Along with clinical reasoning, observations, and nonverbal cues, skillful use of language endows the history with its clinical power and establishes the medical interview as the clinician's most powerful tool.2-5Language is the means by which a physician accesses a patient's beliefs about health and illness,6creating an opportunity to address and reconcile different belief systems. Furthermore, it is through language that physicians and patients achieve an empathic connection that may be therapeutic in itself.7 Because of language barriers, millions of US residents cannot have this connection with their physician. According to the 1990 US Census,8almost 14 million people living in the United States do