By Kiran Malli
Interpreters and the fidelity of your message
Q: I’ve recently started a new job in an emergency department, and some of the patients have limited knowledge of English. What do I need to know about working with an interpreter to overcome the language barrier and ensure patients receive optimal care?
A: There is a saying in the interpreting industry: having two hands doesn’t make you a pianist, and speaking two languages doesn’t make you an interpreter.
Professional health-care interpreters are language specialists with proficiency in medical terminology and a good understanding of the Canadian health-care system. According to a U.S. study that looked at the use of professional versus ad hoc interpreters in pediatric emergency departments, the latter group make almost twice as many interpreting errors of potential clinical consequence.
Accuracy is essential in effective interpreting. It is risky to rely on untrained bilingual individuals on staff or the patient’s family and friends. First of all, they may not be able to speak the languages at the required level, matching message for message, and may either interject English words or omit key information.
Second, patient confidentiality cannot be guaranteed when family and friends act as interpreters. Furthermore, when family members indicate they have the consent of the patient to assist with language issues, we need to query how the consent was obtained.
Third, neutrality is needed to deliver medical information faithfully. Family and friends cannot be expected to be anything other than biased when it comes to the health of loved ones. Family and friends are there to support them through the health-care process, and they should not be burdened with having to deliver your message.
The interpreter’s responsibility is to deliver that message as faithfully as possible, using the appropriate syntax, tone and emphasis. Your role as a health-care provider doesn’t change in an interpreter-assisted session. Maintain the lead during the session and focus on your relationship with the patient, not with the interpreter. You make the introductions, direct the interpreter, if necessary, to where she/he should be positioned, and explain to the patient why the interpreter is in the room:
My name is (name and role). This is (interpreter’s name), the interpreter. The interpreter is here to assist me to better understand you and to help you better understand me. The interpreter will interpret everything said in the session by everyone here. Everything said in this session is private and confidential and will not be repeated outside. As a professional, the interpreter is bound by confidentiality.
Please speak no more than two or three sentences at a time and allow the interpreter time to interpret. I will do the same. If you begin to speak too fast, the interpreter may stop you by raising her hand. Again, this is to ensure the interpreter can accurately interpret what you have said.
Here are some tips and techniques for in-person interpreting sessions:
- Position yourself to maintain eye contact with the patient.
- Speak directly to the patient, not the interpreter (e.g., “What is your address?” rather than “Ask the patient for his address”).
- Use short sentences. Avoid jargon, highly technical terms and idioms.
- Do not ask the interpreter to act as a cultural liaison.
- If you and the interpreter need a conversation for clarification purposes, ask the interpreter to explain the nature of the exchange to the patient.
In an emergency department, on-the-phone interpreting may be all that is available to you. Although you might think this method comes with additional challenges, the procedure is actually quite similar.
Here are specific tips and techniques for on-the-phone interpreting:
- Brief the interpreter first and summarize what you want to accomplish.
- Try to speak clearly and concisely. Give simple, but full, explanations.
- Don’t expect the interpreter to provide explanations to frame your questions.
- Ask for clarification when you feel it is needed, and allow the patient and the interpreter to do so as well.
- Announce the end of the call to both parties before you disconnect.
The Provincial Language Service, operated by the Provincial Health Services Authority, provides interpreting and translation services, in more than 150 languages, to B.C.’s regional health authorities. Last year alone, we handled about 100,000 hours of over-the-phone and in-person interpreting services.
One of the initiatives we are particularly proud of is our workshop-based training program on mental health interpreting. The program grew out of recognition of the influence of culture on how people experience mental illness and mental health problems. With this training, interpreters are prepared to address cultural issues in mental health settings and become integral members of health-care teams. In addition, health-care professionals can receive training in working with interpreters in this expanded role.