This chapter explores the multifaceted communication challenges in Hong Kong’s Accident and Emergency Departments (AEDs), focusing on the unique dynamics of a trilingual clinical environment where Cantonese, Mandarin, and English intersect. Through an analysis of clinician-patient interactions and shared decision-making processes, the chapter identifies key barriers, including linguistic challenges, time pressures, cultural norms, and documentation inconsistencies, which hinder effective communication and patient safety. Using data from interviews, questionnaires, and patient journey recordings, the study highlights the complexities of multilingual communication and the systemic factors that shape clinical interactions. Proposed solutions include standardized communication protocols, language training, patient-centred practices, technological integration, and fostering a non-hierarchical workplace culture. The chapter emphasizes the need for systemic reforms and targeted strategies to enhance communication in high-pressure, multilingual healthcare settings, ultimately aiming to improve patient outcomes and satisfaction.