In this entry I'd like to touch on some of the logistical and ethical difficulties medical interpreters face on a daily basis. Especially in medical settings, I see interpreting as very akin to serving in a restaurant. If you've ever had a job waiting tables, you know how there are a thousand tiny details that come into play in order for you to execute your job well (not just satisfactorily). Factors such as where you place a drink on a tray, how you scoop the ice, how you hand a fork to a guest, or how to carry a tray loaded with 60+ pounds of dishes. If you master these details with a smile on your face, guests often see your job as easy and effortless.

A lot of these logistical factors play a role when interpreting at a doctor's office. The one most frequently faced, and what I'd like to focus on today, is the issue of direct communication between patient and provider. In community interpreting, there is always an ideal that stands in contrast to the norm. The ideal in a medical facility is that a patient and provider speak directly to each other, and not to the interpreter. In some ways, this might seem obvious. The purpose of the interpreter is clearly so the LEP individual can speak for himself or herself, right?

In reality, it very rarely plays out like this, especially at the beginning of an assignment. I would say in at least 50% of my appointments, it starts out with the nurse saying something like "Could you ask him why he's here?" When this happens, I will attempt to immediately chime in (it gets more awkward the longer you wait!) and say pleasantly, "Could you please address the patient directly, as if there were no interpreter present? The interpreter will translate everything you say exactly as you say it." At this point, usually one of three things will happen:

  1. the medical professional will realize the logic of this, respond with "Oh, of course" etc., and will address the patient directly for the remainder of the encounter;

  2. the medical professional will briefly address the patient directly, but after a few sentences will revert back to "ask her/tell him"; or

  3. the medical professional will roll his/her eyes, express some form of annoyance, and continue to address the interpreter.

These three scenarios occur with about equal frequency. Scenario #1 is obviously ideal, so the question is how do we deal with scenario #2 and #3? Here are strategies I have found useful:

  • This is perhaps proven the most helpful: if at all possible, position yourself in the room in a location where it is difficult for the provider to make eye contact with you. I try to position myself slightly behind the provider, which allows him/her to look at the patient directly, and also discourages him/her from looking at the interpreter, since it would be necessary to completely turn around in order to do so.

  • If the room is too small to allow standing behind the provider, and for example the interpreter must sit or stand between the patient and provider, I have my notebook in hand and look down at it, as if anticipating something to write down. I do not look at the provider or the patient while interpreting, which forces them to look at each other. Often, when the individuals are forced to look at each other during the encounter, they realize they might as well just speak to each other directly!

  • In regard to scenario #2 and #3, I have colleagues who will ask the patient and provider repeatedly to address each other directly. I find myself very uncomfortable doing this more than once. If I find myself in scenario #2, I will occasionally request a second time. In scenario #3, I opt for the tactic of doing just what I said I would do: interpret everything. That means if the provider says "ask her where she lives," I say "pregúntele donde vive." In many cases, the patient might say "¿A quién?", after which of course I would say "Ask who?". This might seem like an obtuse or abrasive tactic, but in my experience it's a pointed way to demonstrate to the provider that he/she must take responsibility for the encounter and his/her own words.

This is a logistical as well as an ethical issue. Because in the final scenario, if the provider is addressing the interpreter, the interpreter is in control of the interaction. This is a liability, to say the least. Here's an example from an appointment two days ago:

I was at a clinic interpreting for a mother who's three-month old daughter was receiving a wellness checkup. The medical professional was a nurse with whom I'd worked before, and who I knew had trouble addressing the patient directly (this nurse had given me the eye-roll during my first assignment there when I made my standard request for direct communication). On this occasion, the room allowed me to position myself just behind the nurse, so she could look at and speak directly to mom.

Bizarrely, the nurse would turn 180º to avoid looking at the patient's mother, and would speak directly to me. I refused to make eye contact with the nurse and kept my eyes on my pad and made sure that every word out of her mouth came out of mine in Spanish. Her resistance created a linguistic problem when the nurse asked "How long was she in the hospital?" If I had simply interpreted this to mom as "¿Cuánto tiempo llevó ella en el hospital?", and mom had not considered the ambiguity when answering, we could have ended up with a significant medical discrepancy: moms and babies may or may not spend an equal amount of time in the hospital. At this point, I interrupted the interaction and said to the nurse, "Ma'am, please address the patient directly to avoid ambiguities. If you are speaking to the interpreter and say 'How long did she spend ...', this could mean the mother or the patient, and may not be the same length of time. If you simply address the mother, this miscommunication will be avoided."  That solved the problem for the remainder of that encounter.

If you have your own strategies or any thoughts, please feel free to share. I'm always curious for others' perspectives and approaches to similar situations.