In cross-cultural interaction in medical settings, there is great potential for miscommunication. This potential is increased when the language proficiency of one of the interactants is low. In the data presented here of such interaction, however, the instances of miscommunication are quickly resolved and communication proceeds. Three sources of communicative success are suggested. Most important is the ability of both parties to draw contextually triggered inferences which provide a basis for (1) making perceptual contributions and (2) using communication strategies. These inferencing abilities and communication strategies are guided by the expectation of and search for relevance (Sperber and Wilson 1995) which allows interaction to proceed. A third source of success is the professional knowledge and skill of the interactants which not only enable interaction to proceed but to do so toward professional goals. The implications of these findings contribute to out understanding of models of intentional communication.