Data from multicultural contexts add more complexity to many findings regarding healthcare practices that have been reported in the literature. For example, patient participation has been reported to contribute to the enhancement of healthcare results (e.g. Candlin, 2006; Thompson, 2008). However, patient participation may be problematic when participants in the medical encounter face sociocultural and linguistic barriers. This paper focuses on interactional difficulties that non-native speakers of English encounter in prenatal genetic counseling sessions. These difficulties, it is argued, may place limitations on the extent of patient participation, when patient participation is narrowly defined in terms of verbal contributions. The data for the study come from a prenatal genetic counseling clinic in Hong Kong, and the participants of the interactions originate from various countries in the Asia region. Using a conversation analytic approach, the paper examines interactional difficulties in an attempt to capture the specific challenges faced by healthcare providers and patients in an increasingly diverse healthcare context. It also argues for an ethnographic perspective to examine patient participation in the multilingual context and to highlight dimensions of second language use and cultural diversities as observable evidence of patient participation.