This post is intended as a useful reference for anyone in the healthcare field who works with interpreters: doctors, nurses, receptionists, physician assistants, medical assistants, phlebotomists; the list goes on. If you fall in this category, welcome! I’d like to lay out a very basic primer on how best to work with medical interpreters. Because interpreters usually aren’t on staff, we can seem like somewhat mysterious figures who come and go from facility to facility, and there is often a lack of conversation about how best to work together.
I’m going to list out topics in rough order of importance, and expand on each topic. If you have any take-away from this information, I’d love it to be that the interpreter is really part of your care team, just like anyone who’s on staff in your facility. Fostering a good working relationship with your interpreter can vastly improve patient care. Here are some tips and information on how to head in that direction.
Medical interpreters in Washington State are usually certified and have to undergo continuing education.
The Department of Social and Health Services administers written and oral exams for medical interpreters, and to keep one’s certification, there are certain annual requirements for continuing education and ethics training. All that to say, please realize and have faith in the fact that we are qualified professionals, just like you.
Interpreters are subject to their own code of ethics and to HIPAA.
There are encoded professional standards for our behavior, and we are subject to the same confidentiality requirements as you. Some of the professional standards include faithful and complete interpretation, not being unattended with a patient, and not “relaying” information to a patient (e.g. phone calls).
When working with an interpreter, please address the patient.
This is one of the biggest things interpreters like to stress, but it makes a huge difference. The interpreter is your voice, and is there to, as much as possible, eliminate the language barrier. So please interact with your patient, make eye contact with your patient, and respond to your patient like you would if he or she were speaking English—just leave pauses for your interpreter to speak! Please don’t say “tell him” or “ask her.” The interpreter will use first person, which means if the patient says “my head hurts” (in X language), the interpreter will say “my head hurts” (not “she says her head hurts”).
There are several reasons for this, but in my mind, one of the biggest is personal agency. A good interpreter allows the patient to speak for himself or herself, to not have a third party (e.g. a family member) representing him/her and answering questions.
There’s also the factor of human dignity. You don’t need to understand the language to notice how someone is treating you. I imagine that if I went to my PCP, and he never looked me in the eye or never tried to pronounce my name, I would feel somewhat humiliated. While the language gap can be awkward, please try to speak to the patient, not to the interpreter.
Please make sure to pause sufficiently so the interpreter can interpret.
For most medical appointments, interpreting takes place in what’s called the consecutive mode. This means you speak, the interpreter listens (and maybe takes notes), you pause, the interpreter interprets. I recommend speaking around 2-4 sentences and then pausing for the interpreter. This might seem tedious if you’re new to it, but you should be able to develop a comfortable rhythm of speaking and pausing that doesn’t feel too obtrusive.
Good interpreters will be able to cope with much longer utterances before interpreting, but usually there’s no need; with 2-4 sentences, all parties are assured that nothing’s being left out. If possible, try to be aware of when an interpreter might “butt in” to interpret. This is because there are linguistic factors that make certain cut-off points more opportune, and an interpreter can intuit a good stopping point.
Be aware of extralinguistic communication factors. Your interpreter can help with this.
By extralinguistic, I mean factors like education, literacy level, upbringing, and culture. Some patients are functionally illiterate and haven’t had more than an elementary school education, and may not understand words like “orthotic” or “CT scan” in their own language. Other patients may not be working with an interpreter of their first language (e.g. they may speak an indigenous Latin American language and learned Spanish in school or as an adult). Consequently, such patients may not understand even simpler words like “income,” “assessment,” or “heart burn.”
If you sense a gap in understanding, even with an interpreter present, some of these factors might be at play. Don’t assume that a patient understands just because he/she is speaking through an interpreter. Certain countries and cultures can be ashamed when they do not understand, especially if it’s due to a low level of education, and will not necessarily ask the appropriate questions or express doubt. Feel free to ask the interpreter, in private, if there are any such factors to be aware of.
The interpreter is there to facilitate your communication with the patient.
Please don’t ask an interpreter to explain medical paperwork, relay a message, or summarize information that isn’t coming directly through you. An interpreter can translate paperwork in its entirety, but may not explain it. You may relay a message to your patient, and the interpret will speak your words. The purpose of this is to keep the healthcare professional in the healthcare role and the interpreter in the interpreting role.
Be encouraged if an interpreter asks for clarification on a word or term you use.
This means the interpreter is engaged and attempting to translate your speech faithfully and completely. Dedicated interpreters are committed to glossary building and studying terminology, but because we work in a variety of settings and contexts, it is impossible to know every single word.
Beware the dangers of using family members, minors, or facility staff as interpreters.
Long story short, using an untrained or uncertified interpreter—even if he/she considers himself bilingual—is a dangerous practice that puts the patient at risk. Professional interpreters have received training in terminology, false friends, ethics, and professional practices, such as note-taking and memory. For example, if a patient says estoy intoxicada, it means that she is poisoned, not that she is intoxicated. That's just one example in which a mistake could be detrimental.
Individuals who grew up speaking Spanish at home (called "heritage speakers"), and who have had no professional or academic training in their heritage language, typically have significant linguistic gaps of which they are seldom aware. I recommend that you not expose yourself to this liability.
Consider leaving your high school or college Spanish at the door when it comes to communicating sensitive medical information.
You are a competent, skilled, articulate professional, and this comes across in your speech. The interpreter is there so you can sound the same in a foreign language. Exchanging pleasantries in the Spanish you’ve learned is an excellent way to connect with a patient, but please consider doing what you’re good at in the language you’re good at. This ensures that you are not limited in your phrasing and word choice to the patient when it comes to protecting his/her health. There is also liability involved. The interpreter and the patient are in an uncomfortable position if a serious mistake is made or if your Spanish isn’t clear. Patient care should come first.
Get to know your interpreter!
The providers I work the most seamlessly with are the ones with whom there is mutual trust and respect. The providers who greet me by name, thank me for interpreting, and listen when I explain that the word gripe or gripa in Spanish can mean colloquially either cold or flu. Somehow, inevitably, the providers who know me as a person, who have asked about my work and training, who do not treat me as a commodity, a necessary evil, or a machine, are the ones with whom the encounter and interpretation always seem smoothest and most helpful to the patient.
Thank you for stopping by my blog and I really hope some of these points were helpful to you as a healthcare professional. Please feel free to comment or bring up any topics you’d like to hear about in this same category. I’m happy to keep adding to the list, and don’t hesitate to forward this to any other professionals who might find it useful.