Dr. Mazin Shikara on Multilingual Primary Care: Why the Medical Record Has to Speak the Patient’s Language

At MedFlorida Medical Centers, patients move between English, Spanish and Portuguese in a single visit. Dr. Mazin Shikara argues that documentation built for one language is a patient safety problem, and that AI can help close it if physicians stay in charge of the chart.

Consider a visit that plays out in some form every day. A woman in her sixties sits on the exam table at a MedFlorida Medical Centers clinic in South Florida. She begins in English, describing a pressure in her chest that comes on when she climbs stairs. When her physician asks whether it spreads anywhere, she switches to Spanish to describe an ache along her left arm. A detail about her mother’s heart attack arrives in Portuguese.

Every one of those sentences carries clinical weight. Exertional symptoms, radiation of pain and a first-degree family history are the kind of details that shape a cardiac risk assessment. For most of the history of the electronic health record, capturing them accurately depended on a physician translating in real time while typing a note in English.

“The language a patient speaks should never determine how complete their chart is,” said Dr. Mazin Shikara, the board-certified internist who founded MedFlorida Medical Centers and serves as its President and CEO. “In our exam rooms, the most important sentence in a visit can come in any of three languages. The record has to catch it.”

A region where multilingual care is the default

South Florida is not an edge case. In Miami-Dade County, three in four residents age 5 and older speak a language other than English at home, and more than half of residents were born outside the United States, according to the U.S. Census Bureau’s American Community Survey.

For a primary care network like MedFlorida, that means code-switching, the habit of moving between languages mid-conversation, is a routine feature of the clinical encounter rather than an exception to be handled by an interpreter line.

Shikara, who has practiced internal medicine since 1991 and has led MedFlorida as a multi-location primary care network since 2007, said the burden of that reality has historically fallen on the physician. “A bilingual doctor can follow the patient perfectly well,” he said. “The problem was always the second job: holding the conversation in two languages while composing a clean English note at the same time. Something gives, and usually it’s either the eye contact or the detail.”

The safety evidence behind the language gap

The clinical stakes are documented. A study of 1,083 adverse events reported across six U.S. hospitals, published in the International Journal for Quality in Health Care, found that 49.1% of adverse events involving patients with limited English proficiency resulted in physical harm, compared with 29.5% for English-speaking patients. Among the events that caused harm, the share ranging from moderate temporary harm to death was 46.8% for patients with limited English proficiency, nearly double the 24.4% seen in English speakers. Communication errors were a contributing cause in 52.4% of the adverse events involving limited-English patients.

The inverse is also true. A systematic review in the Journal of General Internal Medicine covering 33 studies found that 76% reported better outcomes when patients and physicians shared a language, including improved glycemic and blood pressure control, higher medication adherence and fewer emergency department visits.

“Those findings match what any internist in a diverse community sees,” Shikara said. “When the patient can tell the story in their own words, you get a better history. When the history is better, the diagnosis is better. The documentation has to preserve that advantage instead of flattening it.”

How the technology works in the exam room

MedFlorida’s response was to deploy an ambient AI scribe, Sunoh.ai, across its practice. The system listens to the natural flow of a visit and generates a structured draft note in English, even when the conversation moves between English, Spanish and Portuguese. Sunoh described the rollout in a press release on the MedFlorida deployment.

Robert DeLuca, MedFlorida’s EMR Innovation Administrator, wrote in a first-person account published by Sunoh.ai that providers who once remained at work until 7 or 8 p.m. now leave around 5:30, and that the practice is seeing clinicians save two to three hours a day.

Shikara is precise about what the tool is and is not, a distinction he said matters to any physician evaluating it.

“It is a documentation tool, not an interpreter and not a clinician,” he said. “Our physicians still conduct the visit in a language the patient understands, and they still review, correct and sign every note. If a medication name, a dose or a negative finding is wrong in the draft, the physician who signs it owns that error. We built our workflow around that principle from the start.”

That review step is where he believes the clinical value is actually protected. A draft that captures a patient’s exact description of symptoms, in context, gives the physician a richer starting point than a note reconstructed from memory at the end of a long clinic day.

What changes for the physician

The benefit Shikara emphasizes most is attention. When a physician no longer has to translate and type simultaneously, the cognitive capacity that went into documentation returns to the patient.

“You catch the hesitation before a patient answers a question about chest pain,” he said. “You notice when someone says ‘a little’ in English and then describes something much worse in Spanish. Those are the moments where primary care either catches a problem early or misses it, and they depend on the doctor actually listening.”

He also sees a workforce argument. Physicians who practice in high-volume, multilingual settings carry an invisible documentation load that their counterparts in English-only practices do not. Reducing it, he said, is part of keeping experienced bilingual clinicians in community primary care, where they are hardest to replace.

A preview of American primary care

Shikara trained at the University of Baghdad College of Medicine, earned membership in the Royal College of Physicians in England and completed his residency at Flushing Hospital Medical Center in New York before building MedFlorida in South Florida. Three decades of practice in some of the country’s most diverse communities have shaped his view that what South Florida experiences today, much of the country will experience soon.

“Every growing city in America is going to have exam rooms that sound like ours,” he said. “The practices that design their documentation, their staffing and their safety checks around multilingual patients now will deliver better care. The ones that treat it as an exception will keep asking physicians to absorb the difference.”

Back in the exam room

The patient finishes her history. Her physician has stayed turned toward her throughout, asking about duration, triggers and what makes the pressure ease. An ECG is ordered before she leaves the building.

When the physician opens the draft note between visits, the exertional pattern, the arm discomfort and her mother’s history are all there in clinical English, ready to be checked, corrected and signed. None of it depended on which language she chose to say it in.