Only English need be spoken here.

There is a debate about English being the official language of America and all Americans. For me it is not a debate; it is a medical necessity. It is not an issue of cultural pride versus cultural highjacking. It is not a matter of Anglophile linguistic neo-colonialism. It is a need to understand my patients.

When my partners and I are not in the office, we use an answering service to help track calls and to facilitate communication. It is our chain. It is also our lifeline. We do not go anywhere without it. With beepers and cell phones, this audio rope is literally tied to our belts wherever we go. However, it can provide access only when the person on the other end can talk to me in a dialect I can comprehend. An answering service is of no help when it does its job of receiving a call, forwarding it to me, but I don't understand a word that is spoken.

One night at home I received a call from a concerned mother (that language is universal). She was describing something about her child. Through the barrier of language I figured out that the child was sick, but that was it. For a pediatrician not to know how sick or the age of the child or how responsive the child is or if there is a fever is frightening. I knew I did not understand her. I had no clue if she understood me. All I could do was repeat slowly, "if your child is sick, you need to go to the emergency room."

But another problem is medicine has its own language. Medical school is a language training center. While there are concepts that are somewhat abstract, mostly it is bulking up on a new language. There are remnants of Latin from a former time, toxicum erythema neonatorum (red rash of newborns) or Greek, xyphoid meaning sword (the lower point of the sternum or breastbone). There are -itis and -oma and -algia added to other words almost like conjugating verbs. Drugs are the worst. It took me a day and a half to finally command "trimethoprim sulfamethoxazole."

Just as Latin was the unifying tongue of the church and law in the Middle Ages and French was the communication standard of diplomacy in the 1700s, English is the vulgar (meaning the common) voice of science in the 20th and 21st centuries. English is the language of democracy. It captures the words and sounds of so many people and places that it has become the world's common communicator.

But communicating in English goes both ways. This is where English needs to enter into the exam room. However, as I listen to myself speak with families I realize I am not speaking English any more than the mother on the phone talking about her child with a fever. I say "otitis media" when I should say "ear infection." I mention "failure to thrive" when "not eating well" would do. I tell the parents to do this or that, and they don't bother doing anything because they did not get it. I did not speak their language.

Physicians need to translate medicinese into the vernacular. Asking if there are questions is not enough; asking for understanding in plain English should be the standard of care.

English is the common language of this country. We should all learn to speak it. Immigrants need to learn to speak English to improve their lives. They need to speak English for me to help improve the lives of their children. And doctors need to speak English so they can improve the lives of their patients.

Joseph Cramer, M.D., is a fellow of the American Academy of Pediatrics, practicing pediatrician for more than 25 years and an adjunct professor of pediatrics at the University of Utah. He can be reached at [email protected]