Some pointers on etiquette and best practice when interpreting in a medical setting.
For the first time in months, I took an assignment for a medical interpreting job. While my language skills are just fine for this setting, I was reminded of how difficult this work really is and how flexible we have to be. The experience also made me remember how nervous I was when I was new, mostly because I had no idea what to expect.
The points addressed here don’t have anything to do with terminology. Terminology and asking for clarification is a different matter. What follows is a basic rundown of what you can expect in an interpreted encounter in the outpatient world.
Professional introduction with front desk, patient and family, and clinical staff: During the initial introductions, I want to make sure that everyone knows I’m the interpreter—not a family member or friend who came with the patient, and not a bilingual staff member getting pulled from her regular duties to interpret. I make it a point to introduce myself not only to the patient, but also to anyone who is with the patient (including children). This helps build rapport quickly and can ease any tension that might be there when you’ve got bilingual family members and you’re afraid they’re going to give you a hard time, which, by the way, almost never happens. The patient’s bilingual family members are not there to harass the interpreter—they just want their sister, mom, dad, etc., to be okay. When I introduce myself to the doctor, I ask if he or she has ever worked with an interpreter before. When doctors aren’t sure how to work with an interpreter, they probably won’t ask, and they’ll be grateful that you brought it up.
Waiting with the patient: It’s time to stop scaring interpreters about being alone with the patient and to start talking about why they don’t want to be alone with the patient. Basically, you don’t want to be there when the patient is telling you about his or her condition and there’s nobody to interpret it to. You don’t want to compromise your neutrality and confuse role boundaries. If the patient wants to talk about the weather while sitting in the waiting room, the world will keep spinning. If she asks you about her condition, politely suggest that she ask the doctor the same question and that you would be happy to interpret it for her.
Sight translation for intake paperwork: There are different ways to do this. One option is to read to the patient what’s on the form and show them where to write. If the patient doesn’t know how to write, you can sight translate the form and write down the patient’s answers. (Sometimes they’ll come right out and tell you they can’t write, sometimes they’ll just ask you to do the writing, and sometimes the family member will fill it out, in the same way I would fill out paperwork for a sick family member.) If patients have questions while you’re filling out the form, make sure to encourage them to ask the doctor.
Consecutive for the interview: The nurse will ask the patient initial intake questions: What medicines do you take? How much do you weigh? Where is your pain, and when did it start? What does it feel like, and how bad is it on a scale of one to ten? I use the consecutive mode for the questions as well as for the patient’s answers.
Simultaneous for the patient: When the patient is describing her pain in more detail, I move to a simultaneous interpreting, maintaining eye contact with the patient to keep her talking while I interpret. (I know that in training we learn this is a no-no, but it can be used to support good communication.) This way the doctor can hear her at the same time she’s motioning to different body parts. Another nice way to use simultaneous is when the patient is going on with a story about what happened. While note-taking for memory and consecutive is great to allow the speaker more time to talk, when you use simultaneous the doctor can have a chance to intervene and redirect the patient, just as he or she would be able to do with an English-speaking patient.
Positioning during an in-office exam or procedure: During the interview, I like to sit next to the patient if there’s room. Wherever I can hear everyone and they can hear me is a good spot. (Don’t be afraid to move around as needed as long as it’s not drawing attention to you.) If the patient is having an exam or procedure, it’s nice to look at a neutral spot so you’re not staring while their boil gets lanced or their toenails get yanked out. If they are exposed, go behind the curtain if there is one, and if not, turn around. I like to actually say (especially with male patients), “I’m turning around now so I can’t see anything.”
Sight translation for instructions: I like it when the nurse goes over the instructions with me first and then I sight translate them to the patient. It’s a nice touch and helps to maintain transparency if you let the patient know that the nurse is explaining the instructions to you first before you read them. You can sight translate anything to the patient without the nurse explaining it to you first, but you’ll want the nurse there so she can answer any questions you or the patient might have. Keep in mind that standards for accuracy in sight translation are the same for any other mode of interpreting.
Neutrality at the check-out desk: It might be tempting to fudge a little so that the follow-up appointment is at a time when you’re available to take the assignment, or to tell the check-out person that the patient requested you for the next visit. However, this creates an obvious conflict, so don’t do it.
Be prepared to take notes: Make sure to take a small notebook and something with which to write. I’m especially challenged by numbers, and they will come flying at you in the medical setting in the form of phone numbers, addresses, weight, height, dosages, times, and dates.
Smile: You can be professional and firm with your role boundaries, but be friendly.
Take time after the assignment to reflect on what went well and what could be done differently next time. Most of all, enjoy the experience of serving others! If you have any tips that might be helpful to new interpreters, I invite you to share them with me.
Elizabeth Essary has over a decade of experience as an interpreter in many different settings. She has a Master of Conference Interpreting from the Glendon School of Translation at York University in Toronto. In 2012, she received her national Certified Healthcare Interpreter™ certification (Spanish) through the Certification Commission for Healthcare Interpreters (CCHI), and in 2013 she was certified through the Indiana Supreme Court Interpreter Certification Program. She is an accredited trainer through the CCHI Continuing Education Accreditation Program, and in 2013 served as an item writer and subject matter expert for CCHI’s written exam. From 2011 to 2015, in her work as language services supervisor at Indiana University Health Academic Health Center, she educated hospital staff on working effectively with interpreters and oversaw the bilingual staff approval program. She also developed a series of workshops to prepare staff interpreters for national certification. You can find her blog at https://thatinterpreter.com. Contact: email@example.com.