Adriana sat quietly looking at the floor with her young son, Pablo, beside her. She looked tired. The two had come in for a follow-up appointment for advice on Pablo’s autism medication. The clinician in the room did not speak Spanish, this family’s mother tongue, so they waited in a polite, mildly uncomfortable silence as a translator dialed in over the phone. The visit commenced. Questions were asked, answered in monosyllables; rinse, repeat. Finally, the young patient lifted his head: “Where’s Pilar?”

Dr. Pilar Trelles, a child and adolescent psychiatrist at the Icahn School of Mount Sinai, is a physician whose native language is shared by many of her patients. Born and raised in Peru, she immigrated to the United States after medical school to begin clinical practice. Twice a week, she leads the psychiatric service in a developmental disability clinic that treats patients on Medicaid. The majority of patients who come to this clinic are newly minted immigrants, many of whom speak little, if any, English, with Spanish and Bengali featuring as two of the most commonly spoken languages among families. Although translation services are readily available, they are not always ideal.