Case Study

Maintaining Ethics Despite Language and Cultural Differences

Mrs. Pham brings her son Binh to your office for the first time for a Texas Health Steps preventive medical checkup. Her friend Mrs. Bui serves as a translator because Mrs. Pham speaks very little English and you speak no Vietnamese. After the exam, which includes an oral evaluation, you recommend establishing a First Dental Home for Binh. Mrs. Bui politely shakes her head and says, “I won’t bother her with that.” What is your ethical responsibility in this case where language and culture clash with best medical practice?

Early childhood caries (ECC) is the leading infectious disease in childhood. As a Texas Health Steps provider, you routinely complete an oral exam and provide anticipatory guidance about daily oral hygiene. You know that a First Dental Home should be established beginning at 6 months old, as recommended by Texas Health Steps, and you want to ensure that Mrs. Pham understands the importance of taking this step for Binh. This visit is an opportunity to promote good oral health for the family and protect Binh from potential complications such as oral pain, impaired speech development, and infection.

Refusal to pass along information or errors in translation are risks when using non-certified interpreters. In this case, it may reflect Mrs. Bui’s unfamiliarity with the benefits of early dental care.

portrait of young boy getting his throat checked
6 years

Guided by medical ethics and best practices, what is your next step?

Remind Mrs. Bui that the decision belongs to Mrs. Pham and that she must have the information necessary to take care of Binh. Briefly explain the importance of First Dental Home referral and ask Mrs. Bui to translate the information for her friend.

Provide a trained and qualified medical interpreter who is fluent in Vietnamese to communicate directly with Mrs. Pham.

Provide Mrs. Pham with a list of local First Dental Home providers who are fluent in Vietnamese and can explain the importance of early dental care for Binh.

Related Texas Health Steps courses

photo of frustrated teen looking tempted by a large dram of whiskey

Adolescent Substance Use

Learn the tools to integrate substance use screening and intervention into practice, employ current evidence-based models to manage patients who use substances or are in recovery, and refer patients.

Credit hours: 1.5 CE

photo of doctor, patient, and nurse all looking happy

Culturally Effective Health Care

Promote effective communication and improve health outcomes for culturally diverse patients and their families. Includes guidelines for obtaining informed consent and using interpretation services in the medical home.

Credit hours: 1.25 CE


About Texas Health Steps

Texas Health Steps’ award-winning online program offers FREE CE courses for primary care providers and other health professionals. These courses offer updated clinical, regulatory, and best practice guidelines for a range of preventive health, oral health, mental health, and case management topics.