An increasing number of immigrants to the United States do not use English as their first, or even second, language. Members of the medical community who treats such patients often do not speak the range of home languages of their patients. As a result of the absence of a common language, many patients are forced to communicate the best they can with their physicians in English. This study focuses the interactions of non-native English speaking patients with their doctors when interpreters were unavailable.

Interactions between health care providers and non-native English speaking patients at a university health clinic were videotaped during routine visits. The patients and providers were then asked to rate their comprehension and perceived comprehension of their co-interlocutor after the medical interview was complete. The patients were asked an additional series of questions requiring them to recall certain parts of the interview such as the cause of their illness, the diagnosis, and the treatment prescribed. The interviews, as well as the patients' debriefing answers, were viewed and the comprehension of the participants rated by a research assistant from the School of Nursing. The primary researcher viewed the interviews and identified, counted, and classified the different types of misunderstandings.

The results of the study show that numerous misunderstandings can occur during a medical interview, despite patients and providers continuing to rate comprehension at a higher level. The new category of a "double covert" misunderstanding is proposed to account for the fact that patients rate their own comprehension as high, but have difficulty accurately recalling the cause of their disease or the treatment regimen. The data reveal that patients believe they completely understand what has been said during the medical interview even as numerous misunderstandings can be identified in the transcripts and debriefings. The research assistant, acting as a third party observer, was able to validate the need for more clarification of the diagnosis and treatments of illness. In the assistant's rating of the patient's comprehension, the rating dropped by nearly 50% between the viewing of the medical interview and the patient debriefing.