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In Reply: Dr Bryan raises an important point in noting that there are significant regional differences in Spanish dialects and vocabulary. US Spanish speakers are diverse with regard to their countries of origin, culture, and immigration circumstances. Clinicians and interpreters may not speak the same dialect of a given language as do their patients.

As Bryan mentions, the English language also has multiple dialects that linguists have categorized as standard (eg, Standard American English, British English, Australian English) and nonstandard (eg, Southern English, Boston English, New York English).¹ Nevertheless, fluent speakers of a given language generally have mutual understanding despite differences in dialect.² For example, a physician who speaks American English can appropriately communicate about end-of-life preferences with a patient who speaks Australian English without major misunderstandings that would be attributable to lack of general fluency in each other's language, even though their dialects differ. Moreover, occasional misunderstandings due to . . . [Full Text of this Article]

Lisa C. Diamond, MD, MPH
diamondl@pamfri.org
Palo Alto Medical Foundation Research Institute
Palo Alto, California

Daniel S. Reuland, MD, MPH
Department of Medicine
University of North Carolina at Chapel Hill

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