Intercultural challenges are common in situations where interacting parties originate from diverse cultures. The situation is even worse when the language barrier is involved between parties of different nationalities. If the parties involved are a patient and a doctor, cultural difference may affect the treatment process in various ways such as misinterpretation of information by both parties. Elisabeth Cardosa’s relationship with her doctor, Ruth does not seem to be fruitful regarding the treatment and care for Mrs. Cardosa. This is mainly due to the language barrier emanating from their cultural differences. Mrs. Cardosa cannot speak or understand English properly. The language barrier between a patient and a doctor affects the treatment process 
Mrs. Madosa’s incapability to properly speak and understand English has forced her to rely on her husband as the key interpreted between her and her medical attendants. This has been a challenge because the doctor is not sure whether George conveys the right message to Elisabeth. For instance, Doctor Ruth informed George that his wife, Elisabeth should follow a prescribed diet because she was developing diabetes. However, the wife continues to eat unhealthily escalating the symptoms of diabetes even though George agrees with the doctors’ advice every time they are communicating. According to , intercultural communication between a patient and a doctor especially where a third party is involved s is characterized by dissatisfaction and misunderstanding. Proper communication between the patient and the doctor is vital in the delivery of high-quality care [1, p. 269]. Mrs. Communication barrier is one of the main challenges experienced associated with cultural diversity in healthcare settings [2, p.25].
Elisabeth’s continued state of poor health especially the new health concern of diabetes can be attributed to her fears of trusting another person with her medical condition. The doctor advised Elisabeth and George to look for a professional English-Filipino interpreter enhance proper communication between the doctor and the patient. However, George argues that the wife cannot trust someone else with her condition. The trust issues arise due to security reasons. Mrs. Cadosa only feels secure around her husband and the daughter who also takes care of her. This is because they are in a foreign land and she does not trust anyone else apart from her core family members. Another reason would be due to their low socio-economic status. Mrs. Cardosa may be avoiding the extra cost which may arise due to the need to have an interpreter every time she visits the hospital. Patients from minority ethnic groups with lower socioeconomic status are likely to experience the inferiority complex, which may cause a disconnect with their doctors . The cultural difference among migrants hinders the treatment process and quality healthcare because there is no proper understanding between the patient and the doctor .
A lot of clinical time is wasted when Elisabeth visits for medical attention because the doctor uses most of the time in the communication process. It is stated in the case that Doctor Ruth uses various approaches including diagrams to enable Elisabeth to understand her condition. If Doctor Ruth had proper skills on intercultural communication such time would not be lost, and she would easily understand what the patient. According to , a doctor with proper intercommunication skills can easily interpret a patient’s message and provide appropriate feedback and care. However, the significance of intercultural communication skills depends on the relevance of the context .
 Paternotte E, Scheele F, Seeleman CM, Bank L, Scherpbier AJ, van Dulmen S. Intercultural doctor-patient communication in daily outpatient care: relevant communication skills. Perspectives on medical education. 2016 Oct 1;5 (5):268-75.
 Paternotte E. Intercultural communication between doctors and patients; a multi-perspective exploration.
 Paternotte E, van Dulmen S, van der Lee N, Scherpbier AJ, Scheele F. Factors influencing intercultural doctor-patient communication: A realist review. Patient education and counseling. 2015 Apr 1; 98 (4):420-45.
 Michalski K, Farhan N, Motschall E, Vach W, Boeker M. Dealing with different cultural paradigms: A systematic review on intercultural challenges of international medical graduates. PloS one. 2017 Jul 17;12(7):e0181330.
 Bakić-Mirić NM, Butt S, Kennedy C, Bakić NM, Erkinovich D, Gaipov ML, Davis B. Communicating with patients from different cultures–Intercultural medical interview. Srp Arh Celok Lek. 2018 Jan;146 (1-2):97-101.